Rapid Reversal of Psychotic Depression Using Mifepristone

@article{Belanoff2001RapidRO,
  title={Rapid Reversal of Psychotic Depression Using Mifepristone},
  author={Joseph K. Belanoff and Benjamin H. Flores and Michelle Kalezhan and Brenda Sund and Alan F. Schatzberg},
  journal={Journal of Clinical Psychopharmacology},
  year={2001},
  volume={21},
  pages={516-521}
}
The rationale for treating psychotic major depression with glucocorticoid receptor (GR) antagonists is reviewed. Five patients with psychotic major depression were given 600 mg of mifepristone in a 4-day, double-blind, placebo-controlled crossover study. All the patients completed the protocol and adverse effects were not observed or reported. All of the five patients showed substantial improvements in their Hamilton Rating Scale for Depression scores while they were receiving mifepristone, and… 
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References

SHOWING 1-10 OF 34 REFERENCES
Possible use of glucocorticoid receptor antagonists in the treatment of major depression: preliminary results using RU 486.
TLDR
Preliminary results suggest that glucocorticoid antagonists may be effective in the treatment of major depression and merit further exploration.
The Treatment of Psychotic Major Depressive Disorder with Drugs and Electroconvulsive Therapy
TLDR
A retrospective chart review of 54 patients demonstrating depression with psychotic symptoms was accomplished with the use of Research Diagnostic Criteria for diagnosis of psychotic major affective disorder, findingAntidepressants alone were found to be ineffective or only partially effective in treating psychotic depression unless somatic or depressive delusions were the only psychotic symptoms.
Response of psychotic and nonpsychotic depressed patients to tricyclic antidepressants.
The response to tricyclic antidepressants (TCAs) is studied in 75 of 121 depressed patients classified as psychotic or nonpsychotic subtypes by Research Diagnostic Criteria. Response was assessed by
Amoxapine versus amitriptyline combined with perphenazine in the treatment of psychotic depression.
TLDR
There was a tendency for the patients treated with amitriptyline plus perphenazine to have higher global response rates, however, the patients given amoxapine had significantly fewer extrapyramidal side effects.
The Dexamethasone Suppression Test as a Discriminator among Subtypes of Psychotic Patients
Summary Plasma Cortisol levels examined at 16.00 hours after dexamethasone in 31 controls and in 34 psychotic patients with various diagnoses, suggests that the ranges of such levels may help to
Urinary free cortisol in psychotic depression
  • R. Anton
  • Psychology, Medicine
    Biological Psychiatry
  • 1987
Psychotic depression: a separate entity?
TLDR
If psychotic depression is no more than a severe variant of nonpsychotic major depression, it should, aside from the presence of the psychotic symptoms, have similar clinical features.
The Clinical and Neuroendocrine Features of Psychotic Depression
TLDR
Patients with psychotic depression were more likely to have bipolar depression, psychomotor disturbance, a family history of schizophrenia, and a more severely disordered hypothalamic-pituitary-adrenocortical axis function.
Rapid reversal of acute psychosis in the Cushing syndrome with the cortisol-receptor antagonist mifepristone (RU 486).
The progesterone-receptor antagonist, RU 486 (mifepristone), is also, at higher concentrations, an effective antagonist of glucocorticoid action in vitro and in vivo (1-3). In normal humans, RU 486...
The endocrine effects of long-term treatment with mifepristone (RU 486).
TLDR
The compensatory overproduction of androgens and consequently of estrogens during long-term RU 486 therapy might limit its use as a single treatment in the treatment of estrogen-dependent cancer.
...
1
2
3
4
...