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Delusional Depression: Tricyclic Response

Alexander H. Glassman, MD; Steven P. Roose, MD
Arch Gen Psychiatry. 1986;43(10):1014. doi:10.1001/archpsyc.1986.01800100108016.
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To the Editor.—  Howarth and Grace1 have suggested that a number of reports indicate that tricyclic antidepressants (TCAs) might work effectively in the treatment of delusional depression, and they have cited three reports.2-4 Our reading is that only the 1978 reanalysis by Quitkin et al2 of Klein's 1959 data might suggest that delusional depressive patients respond to TCAs at a rate equal to that of nondelusional patients. The other two cited studies actually show a lower rate of response among delusional compared with nondelusional patients.The study by De Carolis et al3 is particularly striking because of the sample size (181 delusional patients with a 40% response rate vs 256 nondelusional patients with a 68% response rate; P<.001). Simpson et al4 clearly noted that "depressed patients who were deluded tended to have a higher failure rate than those who were not deluded." Both studies' conclusions

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