Psychotic depression is subject to many controversies. Geriatric psychotic depression has even more, and will be addressed in the presentation. The first controversy relates to whether depression with psychotic features is more frequent in elderly patients. Another controversial issue is the possibility that psychotic depression might be a different entity from the non-psychotic counterpart. The role of an organic component will be discussed as well as the possible presence of cognitive impairment. Differential diagnosis can be difficult in elderly patients that may deny symptoms, have medical conditions or dementia.

Treatment options for psychotic depression include the use of antidepressants, antipsychotics and electroconvulsive therapy among others. The preference of those treatments or its combinations is also controversial and will be discussed and put into context. In addition, current and novel treatment options for treatment resistant or partially responsive psychotic depression will be reviewed. These strategies include optimization, substitution, combination, or augmentation of antidepressants and other agents and different non-pharmacological techniques, all of which will be explained and related to the specificities of the geriatric patient