A 62-year-old woman presents with severe depression, psychomotor retardation, and firm delusions that her organs have rotted away. She has stopped eating and drinking adequately. Rapid definitive treatment is required. Which option offers the highest likelihood of response in psychotic depression with medical compromise?
- A Sertraline monotherapy
- B Interpersonal psychotherapy
- C Electroconvulsive therapy ✓
- D Lithium augmentation of fluoxetine
Correct answer: C. Electroconvulsive therapy
Explanation
Electroconvulsive therapy is the most effective acute treatment for psychotic depression and is indicated when psychosis, refusal of food and fluids, high suicide risk, or need for rapid response coexist. Antidepressant monotherapy performs poorly in delusional depression, and even combined antidepressant-antipsychotic regimens act more slowly than ECT. Psychotherapy alone is inappropriate in this severity. Lithium augmentation is a strategy for partial response, not for acutely ill deluded patients unable to eat.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.
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Written and medically reviewed by the StethoPrep medical team.