What Exactly is Psychotic Depression?

There is a high incidence of depression and psychosis, but there is also an effective treatment.

On its own, major depression is debilitating and frightening. In some people, however, it occurs along with psychosis, a transient mental state characterized by abnormal perceptions, such as hallucinations and delusions.

Psychotic depression, or depression with psychosis, occurs when psychosis occurs alongside major depression. Geriatric patients, in particular, are more likely than others to suffer from psychotic depression, which ranges anywhere from 14 to nearly 50 percent of people diagnosed as depressed.

Assessment of psychotic depression

Mental health professionals take psychotic depression very seriously because it puts the sufferer at a higher risk of self-harm. When people have psychotic depression when they are ill and in their acute phase, the suicide rate is much higher than it is with major depression.

Experts say it is essential to distinguish psychotic depression from psychosis and schizophrenia.  As a condition, psychosis isn’t a disease; it’s caused by an impairment of the part of the brain that helps us distinguish between what is happening internally and externally.

Approximately 3% of the population will experience this at some point. Brain changes can cause a person to see or hear things that aren’t there. The longer the person experiences psychosis without treatment, the more convinced she becomes that what she sees, hears, and believes are real.

Psychosis often resembles schizophrenia, but people with schizophrenia have delusions and hallucinations regardless of whether they are depressed.


Psychotic Depression symptomsTo be classified as psychotic depression, major depression must be accompanied by delusions or hallucinations, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Psychotic features must either be mood-congruent (involving depressive themes) or not mood-congruent (not involving the depressive themes). A psychotic episode is generally accompanied by depressive symptoms, such as delusions of guilt, poverty, or sickness.

With psychotic depression, the patient exhibits a low mood, poor concentration, and feelings of guilt, and lack of self-worth. There can also be psychotic features. The person hears or sees voices or things that aren’t real, which are hallucinations, and believes things that aren’t true, which is a delusion.

You should keep in mind that hallucinations are much less common than delusions in a person with psychotic depression. There are many delusions of a depressing, nihilistic nature. People may say they have cancer, lost all their money, or didn’t pay their taxes, among other things. Interestingly, these delusions might be true on the surface. They exude a sense of reality.

People with psychotic depression often realize that their thoughts may not be quite right, so they keep them to themselves. This is one of the reasons why psychotic depression is difficult to diagnose.

Risk Factors

Trauma in childhood is a major risk factor. When you are young, you are vulnerable to trauma. You are at risk if you lose a parent before age 11, or if you’ve been subject to trauma such as sexual or physical abuse. The risk of psychotic depression also increases for people with these risk factors if they become depressed as adults.

In addition, people with psychotic depression are more likely to develop it as they age. Psychotic depression can affect anyone at any age; however, those in their 60s, 70s, or 80s who had no prior history of psychiatry are not uncommon to develop it. Elderly patients are more likely to suffer from delusions of poverty and somatic delusions, such as believing one has a fatal illness.

Differences between Schizophrenia and Psychotic Depression

It is more likely that the person has schizophrenia if they have pure psychosis without much depression. Typically, schizophrenia is not associated with depression but is associated with hallucinations and delusions that remain for a long time. Additionally, their motivation, thinking, and feelings are diminished.

Schizophrenia generally happens in late adolescence or early adulthood while psychotic depression can occur at any age. Schizophrenia is more persistent than other mental health disorders. Usually, delusions are more bizarre and we don’t make the diagnosis based on what type they are.

Treatment for Psychotic Depression

Psychotic depression can be treated in two ways. Another is electroconvulsive therapy (ECT), which involves combining an antidepressant and an antipsychotic. It depends on the situation and is a decision to be made by the family.

ECT may be used in some elderly patients to avoid the side effects of medication. In some cases, ECT is prescribed, followed by antidepressants and antipsychotics. A talk therapy session can be helpful, but only after medication or ECT has been initiated as the first line of treatment.

Psychotic depression has an excellent prognosis of recovery. If you experience psychotic depression it can cause a lot of disruption in your life, as you can imagine. While it may vary from one person to another, but generally speaking, someone with psychotic depression can return to their normal self within a couple of months of receiving treatment.