Explain psychotic depression and combination treatment — CASC communication station

Open and agenda-set. Name time; ask top worries (weight, schizophrenia label, stopping medicines). [3]

Explain diagnosis. "You had a severe depression that also included false beliefs driven by the illness — we call that depression with psychotic features. It is still a mood disorder diagnosis, not automatically schizophrenia. Schizophrenia is a different long-term pattern where psychosis is the main ongoing problem." [3]

Explain combination. "The antidepressant treats the depression; the antipsychotic treats the psychotic symptoms and helps the overall illness settle. Research including a major trial (STOP-PD) found that combining a medicine like sertraline with olanzapine worked better than olanzapine with placebo for this condition." [1]

Continuation. "After people get better on both, continuing the antipsychotic for a period with the antidepressant can reduce the chance of the illness coming back quickly — that was the message of a follow-up trial (STOP-PD II). We balance that against side-effects like weight gain, and we monitor weight, blood sugar and lipids. We do not stop suddenly without a plan." [2]

ECT. "If depression had been life-threatening — for example not eating, or very high suicide risk — we would discuss ECT, which has strong evidence in severe depression. It was not required in her course so far." [4]

Safety. If guilt, voices, or death wishes return, contact the team/crisis services the same day. Provide written information; teach-back close. Note elevated suicide risk phenotype in psychotic depression historically — take new risk seriously. [5][3]