Psychotic features in patients with major depressive disorder: A report from the european group for the study of resistant depression

Objective: To elucidate the impact of the presence of psychotic features in patients diagnosed with major depressive disorder (MDD) on sociodemographic, psychosocial, clinical, and response characteristics. Methods: A total of 1, 410 DSM-IV-TR MDD patients were included in the present European multicenter study, which was conducted between 2011 and 2016. Analyses of covariance, 2 tests, and binary logistic regression analyses were performed to explore differences in sociodemographic and clinical variables between MDD patients with and without psychotic symptoms. Results: A prevalence rate of 10.92% for psychotic features was found in MDD. Compared to nonpsychotic MDD patients, those with psychotic features were characterized by a higher likelihood for melancholic characteristics (73.38% vs 59.16%, P = .0006), a higher rate of current suicide risk (60.39% vs 44.27%, P = .0002), greater likelihood of receiving inpatient treatment (55.84% vs 32.01%, P < .0001), greater depressive symptom severity (measured by various rating scales), and more often receiving augmentation/combination treatment strategies in general (81.17% vs 58.12%, P < .0001) and add-on therapy with antipsychotics (50.00% vs 22.69%, P < .0001) and benzodiazepines (47.40% vs 31.29%, P = .0001) in particular. Moreover, psychotic symptoms in MDD were highly predictive of treatment resistance, expressed by a more than 2.2-fold higher likelihood for resistance compared to nonpsychotic MDD patients (79.87% vs 35.75%, P < .0001). Only 3.25% of the patients with psychotic MDD achieved treatment response (vs 27.15% of those with nonpsychotic MDD, P < .0001). Conclusions: These findings suggest that adequate diagnosis of psychotic features in MDD should be ensured in routine clinical care. As a combination of antipsychotics and antidepressants represents the first-line treatment option in psychotic MDD, the finding of a 2-fold higher prescription rate for antipsychotic drugs in psychotic versus nonpsychotic MDD patients reflects the current evidence.SCOPUS: ar.jDecretOANoAutActif