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Psychotic depression

Psychotic depression occurs when a severe depressive illness has a co-existing form of psychosis. The psychosis could be hallucinations, delusions, or some other break with reality. Psychotic depression affects around one out of every four people who is admitted to hospital for depression.

How is psychotic depression different from major or clinical depression?

In addition to the symptoms of clinical depression, such as feeling hopeless, worthless, and helpless, psychotic depression also has features of psychosis. For instance, a person with psychotic depression may have hallucinations (seeing or hearing things that aren't really there) or delusions (irrational thoughts and fears).

According to the NHS, a person who is psychotic is unable to distinguish between reality and their imagination. People with psychosis may hear "voices." Or they may have strange and illogical ideas. For example, they may think that others can hear their thoughts or are trying to harm them. Or they might have delusions of grandeur and think they are the Prime Minister or some other famous person.

People with psychotic depression may get angry for no apparent reason. Or they may spend a lot of time by themselves or in bed, sleeping during the day and staying awake at night. A person with psychotic depression may neglect their appearance by not washing or changing clothes. Or that person may be hard to talk to. Perhaps they barely talk or say things that don’t make sense.

People with other mental illnesses, such as schizophrenia, also experience psychosis. But those with psychotic depression are usually aware that the thoughts they have aren't true. They may be humiliated or ashamed of the thoughts and try to hide them. Doing so makes this type of depression very difficult to diagnose.

But diagnosis is important. Having one episode of psychotic depression increases the chance of bipolar disorder with recurring episodes of psychotic depression, mania, and even suicide.

What are the symptoms of psychotic depression?

Common symptoms for patients who are psychotically depressed include:

  • Agitation
  • Anxiety
  • Constipation
  • Hypochondria
  • Insomnia
  • Intellectual impairment
  • Physical immobility
  • Psychosis

How is psychotic depression treated?

Usually, treatment is given in a hospital setting for psychotic depression. That way, the patient has close follow-up with mental health professionals. Different medications are used to stabilise the person's mood, including combinations of antidepressants and antipsychotic drugs.

Does treatment for psychotic depression always work?

Treatment is very effective for psychotic depression. People are able to recover, usually within a year. But continual medical follow-up may be necessary. If the medication does not work to end the psychosis and depression, sometimes electroconvulsive therapy (ECT) is used. It's important for the patient to work with the doctor to find the most effective drugs with the least side effects. Because psychotic depression is serious, the risk of suicide is also great.

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WebMD Medical Reference

Medically Reviewed by Dr Rob Hicks on May 14, 2014

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