Major depression with psychotic features (MD-Psy) is a significant public health problem. In American studies, between 15% (community sample, ECA) and 25% (inpatient sample) of mixed-age patients who meet criteria for major depressive disorder present with psychotic features. Similarly, in a large European epidemiological study, 19% of noninstitutionalized people ages 19 to 100 with major depression had psychotic features. Among geriatric patients who require hospitalization for the treatment of their depression, the prevalence of MD-Psy may reach 45%. Compared with patients with nonpsychotic depression, patients with MD-Psy exhibit greater impairment following resolution of the depressive episode, greater risk of relapse and recurrence, increased number of suicide attempts, prolonged hospitalizations, increased comorbidity, and increased financial dependence.