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Extrapolating from adult studies suggests the atypical antipsychotic medications combined with SSRIs as the treatment of choice for depressed youth who are psychotic (Hughes et al. 2007). Vague or mild psychotic symptoms in a depressed youth may respond to antidepressants alone. How long the antipsychotic should be continued after the psychotic symptoms have improved is unclear, but the recommendation is to slowly taper these medications, with the eventual goal of keeping the child on monotherapy with an antidepressant. If the child is going to be maintained for long periods of time on both medications, side effects associated with the use of atypical antipsychotics and possible interactions with the antidepressants need to be monitored. Noncontrolled reports suggest that electroconvulsive therapy (ECT) may be useful for depressed psychotic adolescents.

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