Psychotic depression is best treated by psychotherapy without medication. If medication is used it should be withdrawn as the patient can tolerate it. Every affect, including depression, has meaning. Depressed patients may feel sad, frightened, angry, undifferentiated negative affect, or no feelings at all. How to deal with sleep disturbances and with suicidal danger is discussed. Several clinical cases are discussed, including a man who was “cured” of depression with insulin coma treatment in his 20s and was rehospitalized nearly every year thereafter for depression. He also suffered from “spontaneous” panic attacks. Medications only partially helped. He began psychoanalytic therapy without medication in his 60s. When the meanings of his panic attacks and his depressions were discovered, he permanently recovered.