Clozapine in the Treatment of Psychotic Refractory Depression

Abstract

A 40-year-old woman suffering from major depression with psychotic features was unresponsive to conventional therapy. After the administration of a wide range of drug treatments and ECT, she received clozapine. Depressive symptoms improved and psychotic features disappeared. It is suggested that clozapine could be efficient in psychotic refractory depression.

Synergistic dopamine increase in the rat prefrontal cortex with the combination of quetiapine and fluvoxamine

“…More recently, several clinical studies obtained evidence that the combination of atypical APDs with selective serotonin reuptake inhibitors (SSRIs) is successful in schizophrenia, psychotic depression, obsessivecompulsive disorder (OCD), and post-traumatic stress disorder (PTSD) (Ostroff and Nelson 1999;Lu et al 2000;Yatham et al 2003;Hillert et al 1992;Shelton 2003). Combination therapies appear to be effective mostly in treatment-resistant cases and produce a more rapid response, possibly because of pharmacological interaction (Dassa et al 1993;Calabrese et al 1996;McDougle et al 2000;Denys et al 2002;Jakovljevic et al 2003;Sokolski et al 2003). Since atypical APDs have affinity for both serotonin (5-HT) and dopamine (DA) receptors, and SSRIs increase 5-HT levels, one might speculate that combination strategies produce significant changes in extracellular dopamine ([DA] ex ) and extracellular serotonin ([5-HT] ex ) levels in different brain areas.…”

Effect of Intravenous Lipid Emulsion on Clozapine Acute Toxicity in Rats

“…Acute antipsychotic drug poisoning is one of the most important reasons for referring to the hospital [9, 10]. Clozapine, highly lipophilic dibenzodiazepine neuroleptics, is one of the most effective for the therapy of schizophrenia and is increasingly being used to treat affective disorders, some neurological disorders, and aggression [11, 12]. Clozapine toxicity has been commonly seen in psychotic patients [13, 14], especially in patients who received different drugs simultaneously [13, 15].…”

Evaluation of newer treatment interventions for psychotic depression

“…In another case study, Dassa et al [17] described the case of a 40-year-old woman with recurrent psychotic depression who responded to clozapine after several unsuccessful trials of various antidepressants and antipsychotic medication, lithium augmentation, and electroconvulsive therapy (ECT). Wood and Rubenstein [18] reported similar results in a 32-year-old woman suffering from severe depression with delusions, hallucinations, and suicidal ideation who had complete remission after being treated with clozapine.…”