Pharmacotherapy of delusional depression: experience with combinations of antidepressants with the neuroleptics zotepine and haloperidol.

The combination of an antidepressant with a neuroleptic is standard pharmacotherapy for delusional depression today. The neuroleptics used are rarely specified: occasionally haloperidol or perphenazine are mentioned. In two different open-treatment studies, consecutively admitted delusional depressed inpatients received a butyrophenone [haloperidol, bromperidol, approximately 10 mg/day (n = 16)] or zotepine [150-200 mg/day (n = 15)] as a neuroleptic in combination with a tri- or tetracyclic antidepressant (amitriptyline, maprotiline, 150 mg/day). There was a significant improvement in both groups in the sum score of the Hamilton depression scale (24-item version), in a subscore of so-called delusional items (items 2, 17, 19, 20, 23, and 24 together), in the subscore of remaining items and also in most single items such as mood, inhibition, agitation, feelings of guilt or hopelessness.