Psychotic Depression: Information, Symptoms, Treatment and More

Psychotic Depression, also referred to as Depressive Psychosis, is a deeply distressing mental health condition.

Essentially, the condition describes the instance where an individual undergoes a major depressive episode (as with Clinical Depression), only with the added input of psychotic symptoms.

It can be very difficult to differentiate this form of depression from other mental health conditions – namely Schizoaffective Disorder. This is a very difficult condition to live with, as it not only involves the debilitating symptoms of Depression, but also psychosis.

While the prognosis for Psychotic depression is far from good, it is sometimes possible to recover from this condition, or at least control its symptoms.

What are the symptoms of Psychotic Depression?

Typically, only those suffering with severe Clinical depression will go on to suffer from Psychotic depression. Severe depression has a profound effect on an individual’s life – making it difficult to make it through each day.

Typical symptoms of severe depression include, but are not limited to:

• Hopelessness and sadness
• Anhedonia
• Fatigue
• Excessive guilt
• Appetite Changes
• Suicidal ideation or self-harm

In the case of Psychotic depression however, these symptoms will be accompanied by moments of psychosis – a psychotic episode. This will normally mean at least one of:

Hallucinations: This is where a person sees or hears something that doesn’t exist outside of their mind. It is also possible to smell, feel or even taste something too while hallucinating. A common hallucination is hearing voices. When someone hears voices, they may believe they are being ordered to do something by the voice, or sometimes the voice may be critical, or abusive. One of the most damaging parts of a hallucination is that the person who is hallucinating believes fully that what they are experiencing is real.

Delusions: A delusion is where an individual has a belief that they believe steadfastly in, though isn’t true. The person involved will be adamant that their belief is true. In the majority of cases however, they will not be correct. Delusions can take on a wide array of forms. An example of a delusion is paranoia – such as the feeling an individual is being spied on. As such, the delusion can have a marked effect on the day-to-day life of the individual.

It is possible to suffer from both Hallucinations and delusions. These psychotic moments usually align with the individual’s depressive symptoms.

For instance, someone may feel due to their excessive guilt that they have done something wrong – such as committing a crime, which can lead to further guilt.

What are the causes of Psychotic Depression?

It isn’t known what causes Psychotic depression. Similarly, it isn’t known why some people suffer from certain types of depression.

Usually, there isn’t just one cause, with more often than not a range of factors triggering the onset of Psychotic depression.

The individual will normally be suffering from severe clinical depression prior to a psychotic episode. Therefore, they will likely be in a state of distress. When the mind is in distress, hallucinations and delusions can develop.

Traumatic or highly-stressful experiences often contribute to the condition, while many suggest a chain of events can cause a “downward spiral” that results in depression, which can exacerbate and become Psychotic depression.

In terms of the Depression that often precedes Psychotic Depression, causes include genetics, trauma, major illness, a chemical imbalance or loneliness.

Psychotic Depression is likely caused by a range of factors. Certain triggers appear to exist, with many vulnerable to developing the condition.

Diagnosis of Psychotic Depression

It is important to see a doctor or mental health professional when suffering from symptoms of severe depression, as it is possible that it could morph into Psychotic Depression.

In the event of a psychotic episode, an individual already with Depression may then be diagnosed with Psychotic depression.

Usually, mental health teams will generally become aware of the onset of Psychotic depression due to a patient exhibiting delusional thinking, or witnessing hallucinations.

In terms of the actual symptoms that need to be present for Psychotic Depression to be diagnosed, the individual should satisfy the following criteria:

• At least five of the following:
  • Depressed mood for the majority of the day, over the course of a few weeks.
  • Loss of interest and enjoyment in formally-enjoyable activities
  • Increase or decrease in appetite and subsequent weight gain/loss.
  • Problems sleeping.
  • General fatigue or lack of energy.
  • Feelings of guilt or worthlessness.
  • Poor concentration, difficulty in decision-making.
  • Thoughts of self-harm and/or suicidal ideation.
• The individual will have experienced at least one episode of Psychosis.

Sometimes a different condition can be diagnosed, if the symptoms merit this. For instance, Psychotic Depression may actually be misdiagnosed as Schizophrenia or Schizoaffective Disorder.

Psychotic Depression is notoriously difficult to diagnose. But once a diagnosis has been made, treatment can proceed.

How is Psychotic Depression treated?

Psychotic depression is a very serious illness that requires extensive efforts to be made to provide effective treatment. The aim is to provide the patient with the means to control their symptoms, and in some cases, achieve remission.

Treatment for Psychotic depression will generally involve a mixture of medication and talking therapy.

Talking Therapy

Talking therapy tends to have limited efficacy in cases of psychosis. However, it may still help in this condition, with various types of therapy put forward:

Cognitive Behavioural Therapy (CBT): CBT is a type of therapy that is used to treat a range of mental health conditions. CBT involves an individual talking face-to-face with a therapist, although sometimes CBT can be conducted in a group setting. CBT attempts to improve an individual’s wellbeing and mood. The therapy focuses on the link between thoughts, feelings and actions. This can be useful for those with low self-esteem, anxiety, unhelpful personality traits or intrusive thoughts. CBT can help an individual understand their feelings more, and in the long run should lead to an improvement in quality of life.

There are a range of other types of talking therapies available. There are many ways that talking therapy can help. We have more information on our Therapy section.

Medication

A combination of antipsychotics and antidepressants are normally prescribed. One antipsychotic and one antidepressant is usually the combination of choice.

Antipsychotics should help relieve the symptoms of psychosis, while antidepressants should help relieve the symptoms of depression. It is likely the individual will have already been taking antidepressants at the time of a psychotic episode – as is customary with severe depression.

An experienced practitioner should be able to prescribe a safe combination of antidepressant and antipsychotic. For example, Fluoxetine and Olanzapine and Venlafaxine and Quetiapine are well-studied combinations.

Antidepressants: Antidepressants can help to improve and regulate mood. They should improve motivation and restore energy. SSRI Antidepressants are the most commonly prescribed. They act on the brain chemical serotonin – which is thought to help in regulating mood and emotion. They may include side-effects such as a dry mouth, sexual problems and nausea, though these should hopefully be short-term. Other classes of antidepressants are available in the event of an inadequate reaction.

Antipsychotics: Antipsychotics (also known as neuroleptics) block the effect of dopamine – a chemical in the brain that is heavily linked to psychotic symptoms like hallucinations. They can also be useful for stabilising mood, and treating anxiety. They are not suitable for everyone however, and are often associated with many side effects like weight gain, dizziness and dry mouth.

Other

It is also possible in cases of severe depression that treatment will be handled by a Community Mental Health Team – these are a team of mental health professionals. Therapy may be delivered in a more intensive format in this case.

In rare cases, hospitilisation may be required. This will only be in cases where an individual is deemed to be at risk of harming themselves or others.

The last line of treatment is Electroconvulsive Therapy, though this is typically only used in the most severe of cases:

Electroconvulsive Therapy (ECT): Electroconvulsive Therapy (commonly referred to as shock treatment) is a treatment that sees an electric current sent through the brain of an individual. The aim is to trigger an epileptic seizure, with the ultimate objective to relieve symptoms of a mental health problem. The human body is fully restrained during the procedure, which also involves a general anaesthetic. Electroconvulsive therapy is normally a last resort. Despite this, ECT actually has an impressive efficacy rate, with many people finding it helps immeasurably.

Summary

Psychotic Depression is an incredibly difficult condition to live with. It is almost like combining two debilitating illnesses into one.

Seeking help for this condition is very important. For added support, our website has plenty of information to assist you.

See Also

• Depression Section
• What is the Prognosis for Depression?
• Therapy Homepage
• Medicine Homepage