The nosological status of major depression with mood-congruent psychotic features was explored by a cross-sectional demographic, clinical and biological assessment and a 7-year prospective follow-up of 2 samples of patients fulfilling, respectively, DSM-III criteria for this condition and for major depression without psychotic features. The 2 patient groups did not differ with respect to demographic and historical features, response to DST and outcome. The global severity of the index episode was greater in psychotics. All nonpsychotics and 69% of psychotics were treated with antidepressants alone or in combination with benzodiazepines, whereas the addition of neuroleptics was required only in 31% of psychotics. A tendency towards an interepisodic diagnostic stability was verified in nonpsychotics more than in psychotics, but was less pronounced than that reported by the authors advocating the nosological autonomy of delusional depression. These data support the view that major depression with mood-congruent psychotic features is not a distinct diagnostic entity, but rather a more severe depressive subtype.