What is the treatment of choice for psychotic depression?

Electroconvulsive Therapy (ECT) is recognized as the treatment of choice for psychotic depression, particularly in cases where the depression is severe and accompanied by psychotic features such as delusions or hallucinations. ECT is considered more effective than medication or psychotherapy in rapidly alleviating symptoms of severe depression, especially when there is a risk of self-harm or when the patient is unable to tolerate other forms of treatment.

The mechanism of ECT involves inducing controlled seizures in the brain, which can lead to significant biochemical changes and improvements in mood. It is typically used when other treatments have failed, when immediate response is necessary, or in cases where the patient is unable to take medications due to side effects or medical conditions.

While medication management and psychotherapy are important components of treatment for depression, they may not provide immediate relief in cases of psychotic symptoms or may take longer to see significant improvement. Hospitalization can be an important part of treatment for safety and stabilization, especially in acute crises, but it is often not a standalone treatment and does not specifically target the underlying psychotic features as effectively as ECT does.