Psychotic Depression Symptoms. RU-486 For Depression ?

Q: Sufferers of psychotic major depression, a severe and debilitating form of mental illness, improve slowly or not at all with standard medication. But researchers at Stanford University Medical Center have used the drug mifepristone, also known as RU-486, to treat these patients quickly and effectively.

A:The treatment is potentially controversial because mifepristone is widely known as a drug that induces abortions. Researchers have learned, however, that certain properties of the drug that lead to pregnancy termination can also help treat psychotic major depression. About 15 percent of patients suffering from major depression experience psychotic symptoms such as paranoia and hallucinations. Antidepressant medications alone are usually ineffective for these patients, and combining antidepressants with antipsychotic drugs improve symptoms for only about 60 percent of them. Electroconvulsive therapy works in roughly 80 percent of patients who try it, DeBattista said, but many decline the treatment because of its stigma. In addition, patients undergoing electroconvulsive therapy or drug combinations may not see results for weeks or even months after starting treatment. 30 patients received either a low, medium or high dose of mifepristone, each day for a week in addition to their standard medications. More than two-thirds of patients in the medium- and high-dose groups showed significant reductions in psychotic symptoms within seven days. During the week, more than 40 percent of the patients in these groups saw their symptoms of depression reduced by half or better, based on standard clinical measures for the disease High levels of the steroidal

hormone cortisol cause the extreme symptoms of psychotic depression. The excess hormone results from an overactive group of glands called the hypothalamic-pituitary-adrenal axis. Psychiatrists believe electroconvulsive therapy works by resetting this axis, returning it to a normal state. Mifepristone blocks one of the cortisol receptors and also may reset the axis, since improvements persisted for patients in the study even after they stopped taking the drug. Schatzberg said patients who receive a course of mifepristone probably will need to take an antidepressant as a maintenance drug, but they will not have to wait weeks or months for an improved mental state.