Major depression with psychotic features (psychotic depression) is a severe, disabling disorder. Compared with nonpsychotic major depression, psychotic depression has been associated with greater severity of depressive symptoms, greater functional impairment, increased risk of suicide, lower rate of recovery, increased risk of depressive relapse and recurrence, and more frequent hospital admissions. There are significant challenges in conducting a treatment study of psychotic depression, including the recruitment, retention, and assessment of patients.