Understanding Psychotic Depression and Finding the Most Effective Treatment

Major depressive disorder is one of the most common of all mental health conditions. About one-fifth of American adults will experience the symptoms of major depression at some point in their lives.

This condition is difficult to manage on its own. But up to 20 percent of those who develop a serious depressive disorder will also experience psychotic symptoms as an outgrowth of their depression. This development can dramatically increase the debilitating nature of the disorder, especially if no medical services are provided.

Psychotic depression, or major depression with psychotic features, is a severe mental health disorder that requires rapid and extensive treatment. Its worst symptoms must be addressed before it can be overcome, and beyond initial intervention, treatment may need to continue for many months.

Major depression with psychotic features is a complex illness that produces a complicated set of symptoms. Depression and psychosis are separate but still interrelated and mutually reinforcing, and the only way psychotic depression can be identified is if symptoms for both conditions are persistently in evidence.

Psychotic features develop after the onset of depression, making the latter the original condition. The telltale symptoms of a major depressive disorder include:

• Chronic fatigue or low energy
• A lack of motivation to perform even simple tasks
• Insomnia or other abrupt changes in sleeping patterns
• Difficulties focusing or concentrating for long periods
• Pessimism or cynicism about everything
• Feelings of guilt or worthlessness
• Changes in eating habits and weight
• Irritability, moodiness
• Emotional flatness or numbness
• Disinterest in previously pleasurable activities
• Social isolation
• Feelings of helplessness or hopelessness
• Suicidal thoughts or behavior

People with depression know that something is not right, but they may not speak about their feelings with others. If the person with depression doesn’t get help, their symptoms will likely intensify, and it is at this point where they may be in danger of slipping into a psychotic state.

While psychotic breaks with reality can be dramatic, initial signs of psychosis may be far less distinctive or clear cut, and may not always be recognized for what they are. In other instances, psychotic symptoms may be shocking and powerful right from the beginning.

The primary symptoms of psychosis that occur in conjunction with major depression include delusions (false and irrational beliefs about the self or the world) and hallucinations (seeing, hearing, or sensing things that aren’t really there). Psychosis causes a person to lose touch with reality, and when it develops their speech and actions will reflect their distress and confusion.

These irrational ideas and perceptions will seem frighteningly and devastatingly real to someone under their influence. They will have no choice but to respond as if their delusions and hallucinations were entirely authentic because from their perspective that’s exactly what they are.

If your loved one develops psychotic depression, it is important to understand that they will be unable to ask for help on their own. It’s also vital to understand that your attempts to talk them out of their delusions will fail. When psychosis develops, you have to ask for professional assistance, and you should do it as quickly as possible to prevent anything tragic from occurring.

Understanding psychotic depression is the best defense against it, and if you can perceive what’s happening and why, you’ll know what to do when the signs become evident.

Major depression can be diagnosed if a person experiences five or more of its distinctive symptoms for a period of at least two weeks. Psychosis manifests in the form of hallucinations and delusions, and if these are reported the diagnosis can be converted to major depression with psychotic features.

Depending on the nature of the hallucinations or delusions, a person may be diagnosed with either mood-congruent or mood-incongruent psychotic depression.

Psychotic symptoms that reinforce feelings of hopelessness, worthlessness, or despair, like hearing voices that tell the person they are inferior or a failure, are consistent with the mood-congruent variety of the condition. Conversely, people with mood-incongruent psychotic depression may experience “positive” mood swings and delusions that seem inconsistent with their depression, possibly resembling the manic states associated with bipolar disorder. Their delusions or hallucinations may convince them that they’re somehow special or controlling events in the world.

As a part of the screening process, psychiatrists and psychologists will look for evidence of other conditions that might cause psychotic reactions. This will be the case even if major depression has been diagnosed first, since depression could occur simultaneously with disorders like schizophrenia or schizoaffective disorder.

If a client or their loved ones report alternating periods of depression and manic episodes, bipolar disorder might be diagnosed instead of depression. Psychotic symptoms can be experienced as an effect of severe mania, which means psychotic depression will not be diagnosed if the evidence suggests bipolar disorder is the more likely explanation.