[Treatment of depression secondary to psychotic disorders]

Abstract

More than 25% patients suffering from psychotic disorders would show during their evolution some depressive disorders. More than 10% would die from suicide. Secondary depressions following psychotic disorders are heterogeneous. They have to be specified in order to assess therapeutics including biological psychological and socio-environmental approaches. Treatment of depressive disorders correlated to psychotic symptomatology, being mood congruent or not, is the same as characterized depression. However it is preferred to associate antidepressant and neuroleptic or electroconvulsivotherapy. Depressive symptomatology in psychotic disorders is mostly secondary due to delusion, negative or even deficit symptomatology. It often requires to adapt individual choice and posology of antipsychotic treatment. Depressive states in "post-psychotic" phase, secondary to acute phase or in the evolution of chronic psychosis, may be for some of them linked to neuroleptic treatment side effects: in this case, posology and indication have to be discussed. In other cases, it may be indicated to prescribe antidepressant or even electroconvulsivotherapy after having considered the existence of psycho-dynamic reorganization and the need of psychotherapic, social or institutional support. The existence of depressive disorders in the evolution of psychosis leads to ask about their significance: psychological reaction, comorbidity of two distinct pathologies, evidence of continuum between affective disorders and schizophrenia.