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The article frames diagnostic severity, epidemiology, and risk factors, then emphasizes guideline-supported first-line options using electroconvulsive therapy or combined antidepressant–antipsychotic pharmacotherapy.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/savvy-psychopharmacology-management-of-major-depressive-disorder-with-psychotic-features/639334/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/savvy-psychopharmacology-management-of-major-depressive-disorder-with-psychotic-features/639334.png","ImageObject",300,407,{"name":42,"@type":43},"Danger 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Barr, PharmD, BCPP, Ben Miskle, PharmD, and Christopher Thomas, PharmD, BCPS, BCPP  \nVicki L. Ellingrod, PharmD, FCCP  \nDepartment Editor  \nSavvy Psychopharmacology is produced in partnership with the College of Psychiatric and Neurologic Pharmacists  \n[cpnp.org](cpnp.org)  \n[mhc.cpnp.org](mhc.cpnp.org) (journal)  \n30  \nCurrent Psychiatry  \nFebruary 2021  \nM  \nrs. C, age 56, has a history of major depressive disorder (MDD) . She has been stable for 5 years without  \nmedication. Six months ago, she presented to you, along with her son, seeking help. She reported that she had been experiencing insomnia, fatigue, and was not engaging in hobbies. Her son told you that his mother had lost weight and had been avoiding family dinners. Mrs. C reported recurrent thoughts of dying and heard voices vividly telling her that she was a burden and that her family would be better off without her. However, there was no imminent danger of self-harm. At that appointment, you initiated sertraline, 50 mg/d titrated to 100 mg/d, andolanzapine, 5 mg/d.  \nSince that time, Mrs. C has followed up with you monthly with good response to the medications. Currently, she states her depression is much improved, and she denies hearing voices for approximately 5 months.  \nDr. Barr is a Clinical Psychiatric Pharmacist, Eastern Oklahoma VA Healthcare System, Tulsa, Oklahoma. Dr. Miskle is a Clinical Psychiatric Pharmacist, University of Iowa Hospitals and Clinics, Iowa and Clinical Assistant Professor, University of Iowa College of Pharmacy, Iowa City, Iowa. Dr. Thomas is Director, PGY-1 and PGY-2 Residency Programs, Clinical Pharmacy Specialist in Psychiatry, Chillicothe VA Medical Center, Chillicothe, Ohio, and Clinical Associate Professor of Pharmacology, Ohio University College of Osteopathic Medicine, Athens, Ohio.  \nDisclosures  \nThe contents of this article do not represent the views of the US Department of Veterans Affairs or the US Government. This material is the result of work supported with resources and the use of facilities at the Chillicothe Veterans Affairs Medical Center in Chillicothe, Ohio. The case presented in this article is fictional and does not represent a specific case or person(s).  \nThe authors report no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.  \ndoi: 10.12788/cp.0092  \nBased on her presentation and response, what do the data suggest about her length of treatment, and when should you consider tapering the antipsychotic medication?  \nIn DSM-5, MDD with psychotic features is a severe subtype of MDD that is defined as a major depressive episode characterized by delusions and/or hallucinations.1 In the general population, the lifetime prevalence of this disorder varies from 0.35% to 1%, and the rate is higher in older patients.2 Risk factors include female gender, family history, and concomitant bipolar disorder.2  \nPractice Points  \n• In patients experiencing major depressive disorder (MDD) with psychotic features,  \nconsider electroconvulsive therapy or an antidepressant in combination with an antipsychotic.  \n• Any antipsychotic can be considered for the treatment of MDD with psychotic features because there are no head-to-head trials. However, because second-generation antipsychotics have a lower risk of adverse effects, they should be preferred to first-generation antipsychotics.  \n• When prescribing combination therapy,  \ncontinue treatment for at least 9 months to reduce the risk of relapse, and consider reducing the dose of the antipsychotic medication after 1 year of treatment.  \n• When stopping antipsychotic therapy, implement a slow and gradual taper  \nto allow for assessment of symptom recurrence.  \nSavvy Psychopharmacology   \nEpidemiologic studies have shown that psychotic features can occur in 15% to 20% of patients with MDD. The psych","cbCaioS1qhyp15b9","https://ap.wps.com/l/cbCaioS1qhyp15b9","pdf",158872,"English","# Case and treatment course\n## DSM-5 context and risk factors\n# Practice points and treatment strategy\n## ECT vs pharmacotherapy first-line options\n## Combined antidepressant and antipsychotic therapy","[{\"question\":\"How should treatment for MDD with psychotic features be selected initially?\",\"answer\":\"Guidelines recommend electroconvulsive therapy (ECT) or combined antidepressant plus antipsychotic medication as first-line options.\"},{\"question\":\"What is the rationale for using antidepressant and antipsychotic combination therapy?\",\"answer\":\"Combination therapy is more effective than either medication alone, and certain studied regimens (e.g., sertraline plus olanzapine) show superiority to monotherapy.\"},{\"question\":\"When should you consider tapering the antipsychotic, and how?\",\"answer\":\"Continue combination treatment for at least 9 months, consider reducing the antipsychotic dose after 1 year, and when stopping implement a slow, gradual taper to assess symptom recurrence.\"}]","Savvy Psychopharmacology - Management of major depressive disorder with psychotic features | PDF"]