Depression is a frequent mental disorder in the midst of society. . Severe depression with psychotic symptoms is one of a severe depression that is at risk to harm a successful self or others. According to WHO in 2017 depressed people occupy first order in East and South Asia region. Indunesia is ranked as the world's leading country after India with 9,162,886 cases as the increasing incidence of depression is necessary to do research in Grhasia Mental hospital Yogyakarta. The study aims to find out how to figure out the patterns of antidepressant use in severe depressive patients with psychotic symptoms and evaluation of the use of antidepressant drugs in severe depressive patients with psychotic symptoms. The study uses a descriptive observational design with retrospective data retrieval with Mauri medical record of patients, conducted Cross sectional. The sampling technique used is Total sampling. With patient inclusion criteria a number of 45 patients diagnosed with severe depression with psychotic symptoms referring to the WHO 1985 guidelines which include 4T (right indication,right medicine,right patient,right dosage). From the research results of Products that the most widely used single antidepressants are SSRIS whose medication is fluoxetin with a total of 29 patients (64, 4%). For a combination of the most widely used antidepressants are the group of TCA + SSRIS namely Amitriptylin + Fluoxetin as much as 6 patients (13, 3%). In the combination of antidepressant drugs with the most high added therapy in antidepressants + Antiparkinsonian is trihexypenidil with a total of 43 patients (95, 6%). Assessment results of the accuracy of the use of antidepressant drugs Products 100% precise price, 100% appropriate drug, 100% right patient, and 91, 1% precise dose.