Psychotic depression is a subtype of major depression that occurs when a severe depressive illness includes some form of psychosis. The psychosis could be hallucinations, delusions or some other break with reality. Psychotic depression affects almost one out of every four people admitted to the hospital for the treatment of depression
Symptoms of psychosis
A person who is psychotic is out of touch with reality, (National Institute of Mental Health). Being through psychosis (psychotic episodes) means experiencing:
- Delusions – thoughts or beliefs that are unlikely to be true
- Hallucinations – when a person hears (and in some cases feels, smells, sees or tastes) things that aren’t there, a common hallucination is hearing voices
The delusions and hallucinations almost always reflect the person’s deeply depressed mood – for example, they may become convinced they’re to blame for something, or that they’ve committed a crime. People with psychotic depression may:
- Get angry for no obvious reason.
- Spend a lot of time by themselves or in bed, sleeping during the day and staying awake at night.
- Have poor hygiene, like neglecting appearance by not bathing or changing clothes.
- Be hard to talk to. Perhaps he or she barely talks or else says things that make no sense.
- Have “Psychomotor agitation”, i.e., not being able to relax or sit still, and constantly fidgeting. Or, at the other extreme, a person with psychotic depression may have “psychomotor retardation”, where both their thoughts and physical movements slow down.
- Be at greater risk than normal of thinking about suicide.
People with other mental illnesses, such as schizophrenia, also experience psychosis. But those with psychotic depression usually have delusions or hallucinations that are constant with themes about depression (such as worthlessness or failure), whereas psychotic symptoms in schizophrenia are more often odd or doubtable and have no obvious connection to a mood state (for example, thinking strangers are following them for no reason other than to persecute them). People with psychotic depression also 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. Its treatment is different than for non-psychotic depression. Also, having one episode of psychotic depression increases the chance of bipolar disorder with recurring episodes of psychotic depression, mania, and even suicide.
Symptoms of Psychotic Depression
The common symptoms for patients having psychotic depression include:
- Intellectual impairment
- Physical immobility
- Delusions or hallucinations
Symptoms of severe depression
Having severe clinical depression means feeling sad and hopeless for most of the day, practically every day, and having no interest in anything. Getting through the day feels almost impossible. Other typical symptoms of severe depression are:
- fatigue (exhaustion)
- loss of pleasure in things
- disturbed sleep
- changes in appetite
- feeling worthless and guilty
- being unable to concentrate or being indecisive
- thoughts of death or suicide
Causes of Psychotic Depression
The cause of psychotic depression is not fully understood. What we do know is that there’s no single cause of depression and it has many different triggers. For some, stressful life events such as bereavement, divorce, serious illness or financial worries can be the cause. Genes probably play a part, as severe depression can run in families, although it’s not known why some people also develop psychosis. Many people with psychotic depression will have experienced hardships in childhood, such as a traumatic event.
Treatment of psychotic Depression
Treatment for psychotic depression involves:
- Medication – a combination of antipsychotics and antidepressants can help relieve the symptoms of psychosis
- Psychological therapies – the one-to-one talking therapy cognitive behavioral therapy (CBT) has proved successful in helping some people with psychosis
- Social support – support with social needs, such as education, employment or accommodation
The patient may need to stay in hospital for a short period while they’re receiving this treatment. Treatment is usually very effective, although patients may need to be continuously monitored in follow-up appointments.
Help your Loved Ones
People with psychosis are often unaware that they’re thinking and acting strangely. Because of this lack of insight, it’s often down to the friends, relatives or carers of a person affected by psychosis to seek help for them.
If you’re concerned about someone you know and think they may have psychosis, you should contact “us”, because we have trained and experienced team of professionals to handle these conditions.
If you think the person’s symptoms are placing them at possible risk of harm you can:
- Contact with us urgently for Emergency Help in Psychiatric Crisis.
- Call us and ask for an ambulance.