Delusional depression. A distinct clinical entity?

The prognostic importance of delusions in the depressive syndrome had been a major focus of study before somatic therapies were available. Recently, the growing evidence that delusional depressives respond at a significantly lower rate to tricyclic antidepressants than do nondelusional depressives has revived this interest. That evidence is reviewed, and the demographic data and pretreatment clinical phenomenology of a series of hospitalized depressed patients were analyzed to see if differences existed between the delusional and nondelusional groups. Delusional unipolar depressives were less likely to recover while receiving placebo, had significantly more psychomotor retardation, and showed a trend toward fewer previous episodes than nondelusional unipolar depressives.