Psychotic depression in younger patients has been associated with an increased rate of suicide, refractoriness to somatic treatment, and overall poor prognosis. However, the public health and scientific significance of this disorder in older patients has received limited attention in the past two decades; the topic was excluded from the 1991 NIH Consensus Development Conference on the Diagnosis and Treatment of Depression in Late Life. To address this obvious need in the field, a special work-group of recognized experts met in a special NIMH workshop to review and discuss clinical issues and key research questions. This is a report of that workshop's proceedings.