Table of ContentsView AllTable of ContentsDefinition of PsychosisSymptomsCausesDiagnosisTreatmentCopingFrequently Asked QuestionsA Word From Verywell
Table of ContentsView All
View All
Table of Contents
Definition of Psychosis
Symptoms
Causes
Diagnosis
Treatment
Coping
Frequently Asked Questions
A Word From Verywell
Psychotic depression is a subtype ofmajor depressive disorder (MDD). It is also referred to as MDD with psychotic features.
Psychotic depression symptoms are the same as those of MDD, such as feeling sad, listlessness, and having sleep problems, but they also include symptoms of psychosis. The hallmark symptoms of psychosis are hallucinations and delusions.
This article will discuss the symptoms, causes, and treatment of psychotic depression.
Verywell / Jessica Olah
Psychosis is not a condition in and of itself, but rather a symptom or an experience.
Psychosisrefers to the experience of losing touch with reality. This primarily happens in two ways:
A person experiencing psychosis can have either hallucinations or delusions, or a combination of both.
Symptoms of psychosis (sometimes described as a psychotic episode) are generally part of a bigger condition such asschizophrenia,depression, orParkinson’s disease.
Psychosis can also occur with certain medications, substance use, or other health problems.
What Does Depression Feel Like?
Depression with Psychotic Features
In the past, the term “psychosis” was used to describe severity in terms of depression. It indicated that a person with depression was severely mentally impaired and could not adapt to the demands of daily life. Hallucinations or delusions were not part of the diagnosis.
Psychotic depression affects approximately four out of 1,000 people in the general population. This rate increases with age, affecting between 14 and 30 people out of 1,000 who are more than 60 years old. The rates of psychotic depression are significantly higher in people with MDD.
Psychotic Depression StatisticsBecause people with psychotic depression are often hesitant to let others know they are experiencing psychotic features, most statistics are believed to be underrepresentations. The rate of people with psychotic depression is likely higher than currently reflected in studies.
Psychotic Depression Statistics
Because people with psychotic depression are often hesitant to let others know they are experiencing psychotic features, most statistics are believed to be underrepresentations. The rate of people with psychotic depression is likely higher than currently reflected in studies.
Symptoms ofMDDcan vary from person to person and range from mild to severe. For a diagnosis of MDD, symptoms must last at least two weeks and must represent a change in the person’s prior level of functioning.
They may include:
A person experiencing psychotic depression has the classic symptoms of MDD and also hashallucinationsand/ordelusions.
People with psychotic depression are at an increased risk of self-harm and of suicidal thoughts and actions.
Early intervention is important to help keep a person with psychotic depression safe. If you or someone you know is showing symptoms of psychotic depression, seek an evaluation with a healthcare provider or mental health specialist right away.
Help Is AvailableIf you or someone you know are having suicidal thoughts, dial988to contact the988 Suicide & Crisis Lifelineand connect with a trained counselor.
Help Is Available
If you or someone you know are having suicidal thoughts, dial988to contact the988 Suicide & Crisis Lifelineand connect with a trained counselor.
Psychosis Without Depression
Psychosis can occur withoutmood disorderssuch as depression.
Other disorders that may involve psychosis include:
Psychosis is commonly associated with schizophrenia, but psychotic depression and schizophrenia are different conditions with distinct diagnostic criteria and treatments.
Psychotic Depression vs. Schizophrenia
Depression is incredibly multifaceted and can affect anyone. This makes it difficult to pinpoint exact causes of MDD.
Instead, research focuses on correlations instead of causation. While researchers haven’t pinpointed whether these risk factors cause depression, they do note that there are commonalities among people who have depression.
Right now, the risk factors for MDD are applied as risk factors for psychotic depression. This may change as psychotic depression is studied further.
What Is Unipolar Depression?
Risk Factors
Risk factors for depression include:
A four-year longitudinal study suggested other risk factors for MDD might include:
If the criteria for MDD are met, and the person is experiencing hallucinations and/or delusions at the same time as the MDD episodes, a diagnosis of psychotic depression can be made.
Labs and Tests
There are a number of diagnostic tools a healthcare professional may use to make a diagnosis of psychotic depression.
History and Physical Exam
During an initial appointment, a healthcare professional will take a thorough history and may do a physical exam to get a picture of overall health and to discuss current concerns. This may involve:
Laboratory Tests
While there are no lab tests for depression, urine samples, blood tests, or other lab tests may be run to check for other conditions that could be causing the symptoms, or to get an idea of overall health.
Rating Scales
Some healthcare providers might administer questions from a rating scale such as the Clinical Interview for Depression or the Hamilton Rating Scale for Depression (HAM-D).
A 2013 study found that using a combination of rating scales and screening tools may be more helpful for diagnosing psychotic depression than depression scales alone.
Referrals
A referral to a mental health specialist may be needed for a diagnosis, treatment, or both.
If you or your loved one needs more specialized care, ask your primary healthcare provider for a referral to a mental health expert.
Misdiagnosis
In the study, psychotic depression was most commonly misdiagnosed as a different mood disorder.
People with MDD often don’t report psychotic symptoms or they minimize them. Some reasons for this may include:
Healthcare providers and loved ones of people with MDD should not assume that psychotic symptoms are not present just because the person hasn’t mentioned them. Further investigation may be needed.
Why Is the Science on Psychotic Depression Often Unclear?Studying psychotic depression accurately can be a challenge.The definition of psychotic depression among clinicians has evolved greatly over time, making findings between studies difficult to compare.People with MDD often don’t disclose, or don’t realize, that they are experiencing psychotic symptoms, which can also skew results and statistics.
Why Is the Science on Psychotic Depression Often Unclear?
Studying psychotic depression accurately can be a challenge.The definition of psychotic depression among clinicians has evolved greatly over time, making findings between studies difficult to compare.People with MDD often don’t disclose, or don’t realize, that they are experiencing psychotic symptoms, which can also skew results and statistics.
Studying psychotic depression accurately can be a challenge.
The definition of psychotic depression among clinicians has evolved greatly over time, making findings between studies difficult to compare.
People with MDD often don’t disclose, or don’t realize, that they are experiencing psychotic symptoms, which can also skew results and statistics.
It is rare for psychotic depression to resolve without treatment.
Treatment for psychotic depression typically involves medication and/or electroconvulsive therapy (ECT), electrical stimulation of the brain.
Lifestyle
While unlikely to be effective treatments for psychotic depression on their own, some lifestyle changes can help with symptom management, treatment support, and quality of life. These might include:
Talk Therapies
Psychotherapy (talk therapy) on its own has not been shown to be effective at treating psychotic depression. It is sometimes used in combination with other types of therapies and medications.
Some new psychotherapies are showing promise for treating psychotic depression.
Electroconvulsive Therapy (ECT)
ECT is a procedure in which a seizure is induced through a brief application of electric current to the brain through the scalp. It is performed under general anesthesia.
ECT is considered a safe and effective treatment for psychotic depression. It may be more effective than medication, and it is recommended as a first-line treatment in many guidelines because of its quick results.
ECT has been shown to be very effective in reducing suicidal ideation, or intent, in people with MDD who had previously expressed such thoughts.
While ECT often provides quick relief, on-going treatment (such as with medication) is often needed for lasting results.
Prescriptions
A combination of an antipsychotic and an antidepressant medication is usually more effective for treating psychotic depression than treatment with either medication alone.
Antipsychotic medications that may be prescribed include:
Antidepressants that may be prescribed include the following types:
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin and noradrenaline reuptake inhibitors (SNRIs)
N-Methyl-D-Aspartate (NMDA) receptor antagonists
Selective serotonin 1a (5-HT1A) receptor agonists
Many of these medications can come with potential side effects and risks, such as suicidal thoughts and behaviors, sexual dysfunction, and weight gain.However, Exxua does not come with risks or side effects like weight gain and sexual dysfunction.
People with psychotic depression and their healthcare providers need to weigh the benefits against the risks of medications and their combinations.
It may take up to eight weeks to see a response to these medications with psychotic depression. In cases where immediate help is needed, ECT is often offered instead of, before, or along with medication.
While undergoing treatment for psychotic depression, there are ways to help cope with symptoms and improve general quality of life.
Where to Find SupportSupport groups can be helpful for finding resources and connecting with others who understand what you are experiencing.ADAA Online Support GroupMental Health America (MHA)7 Cups of TeaDepression and Bipolar Support AllianceNAMI Connection
Where to Find Support
Support groups can be helpful for finding resources and connecting with others who understand what you are experiencing.ADAA Online Support GroupMental Health America (MHA)7 Cups of TeaDepression and Bipolar Support AllianceNAMI Connection
Support groups can be helpful for finding resources and connecting with others who understand what you are experiencing.
How does psychotic depression differ from schizophrenia?
Schizophreniais a psychotic disorder, while psychotic depression is a mood disorder.
Schizophrenia is a stand-alone condition, while psychotic depression is a subtype of major depressive disorder.
While both conditions result in psychotic symptoms, such as hallucinations and/or delusions, with psychotic depression these psychotic symptoms happen at the same time as major depressive episodes.
What Is Schizophrenia?
Is psychotic depression manageable?
Psychotic depression is often debilitating for the people experiencing it and those around them. Thankfully, treatment is available, such as medications and/or electroconvulsive therapy.
How do you know if you’re having a nervous breakdown?
“Nervous breakdown” is not a medical term, but it is often used colloquially to mean intense mental and emotional distress.
In terms of major depressive disorder, symptoms of psychosis, including hallucinations and delusions, can occur. When this happens, it is called MDD with psychotic features, or psychotic depression.
Are you disabled if you have psychotic depression?
A person with psychotic depression must be given reasonable accommodations, including a flexible work schedule, and is offered protection against discrimination, such as with employment or housing.
Psychotic depression can be intrusive and scary, greatly affecting a person’s ability to function and their relationships with others. Thankfully, treatments are available to help manage symptoms and often achieve remission.
If you or a loved one are experiencing symptoms of psychotic depression, make an appointment with a healthcare provider or mental health specialist to discuss a diagnosis and make a treatment plan.
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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