July 13, 2024

Psychotic Depression

Everyone suffers from the blues at one time or another.  The feeling of being down is usually short-lived, however, and normal mood is quickly restored.  Yet, for some people, depression is a constant companion that makes day-to-day living a challenging proposition.  The challenge is greater still for those individuals who suffer from psychotic depression.

What is Psychotic Depression

Psychotic depression is clinical depression that is unipolar and severe with the additional element of psychosis.  More properly referred to as psychotic major depression – or PMD for short – it differs from non-psychotic depressions because of the psychosis.   However, people with other forms of depression may experience some of the same aspects as psychotic major depression.   For example, some depressed bipolar individuals do suffer some of the same symptoms as psychotic major depression patients.

In some instances psychotic depression can present as a chronic disorder.  However, it is mostly acute, occurring in separate and distinct episodes.  For clarity and understanding, a chronic disorder is one which lasts beyond three months or is persistent.  In contrast, an acute disorder starts suddenly but is short-lived.

According to Wikipedia, psychotic depression is an affliction that affects four in every thousand people.  The psychotic behavior is extremely bizarre in nature.

It is probably more correct, and indeed preferable, to state that someone experiences episodes of psychosis than to refer to someone as psychotic.  Such a reductive statement negatively impacts a person’s very essence and individuality.

What Causes Psychotic Depression

The exact cause of psychotic depression is unknown.  While it is not hereditary, there is a greater chance of developing the disorder if there is a history of depression in the family.

Some researchers have found a link between bad childhood experiences and depression.  Other researchers postulate that elevated levels of the stress hormone cortisol may play a part because raised levels of the hormone are found in depressed individuals, as well as in those suffering from other types of mental disorders.

Studies indicate that there is an increased likelihood of another psychotic episode if a person has had one before.   Two or three psychotic episodes further increase the risk of more recurrences.

Does Everyone with Clinical Depression Develop Psychosis

Psychosis is not common to everyone who is clinically depressed.   In fact, it is rare given the great number of people who suffer from clinical depression.  Mental health researchers have no idea why some depressed individuals experience psychoses but others do not.  There are no predictive tools to indicate who will and who will not develop psychosis.

Approximately 10 percent to 15 percent of people suffering from the most severe form of unipolar depression will experience psychotic symptoms at some point in their lives.

How Psychotic Depression is Diagnosed

When someone presents with symptoms, he or she will undergo a physical examination by a physician.  Questions will be asked about the person’s symptoms and medical history, and the doctor should be told about all of the symptoms that are being experienced.

To insure that there are no other medical or complicating disorders causing the symptoms, the doctor will likely request urine and blood tests to rule out other conditions.

The symptoms reported will give the doctor a good idea about the severity of the disorder.

Common Symptoms of Psychotic Depression

The following symptoms all appear to be common among people suffering from psychotic depression:


• Psychotic Tendencies

These are mostly delusional, whereby patients lose touch with reality and experience all manner of negative thoughts and feelings.  Hallucinations may also be experienced.  With auditory hallucinations, voices are heard in the head, and the voices threaten or criticize the individual.  The voices may order the person to carry out harmful acts.  Visual hallucination involves seeing things that are not there.


• Anxiety

• Agitated behavior

• Insomnia

• Cognitive impairment

• Constipation

• Hypochondria – patients are convinced that problems exist with their bodies and health even when such is not the case.

• An inability to take any kind of action, not even to rouse oneself

• Suicidal thoughts

How Psychotic Depression is Treated

So severe is the disorder, and so at-risk is the patient, that the importance of early intervention and treatment cannot be overstated.

anger and depressionTreatment for psychotic depression is usually undertaken in a hospital so as to closely monitor the patient.  Antidepressants are usually given in combination with anti-psychotic drugs.  The medications act on chemical messengers in the brain, known as neurotransmitters, to improve the patient’s mood and to relieve symptoms.

Depending on the severity of the disorder, treatment may last for only a short period of time or it may be an extended course of treatment.  In some cases, a patient may have to commit to medical follow-ups on a regular basis.

Guidelines for those Suffering from Psychotic Depression

  • People should call for help if suicide thoughts or thoughts of harming others present themselves.  They should call 911 or the national suicide hotline.  The telephone number is: 1-800-273-8255.  Alternatively, they should go straight away to the emergency room of their nearest hospital.
  • Patients should contact their physicians if it appears that medications are hot helping with the symptoms, or if the side effects cannot be tolerated.
  • Patients should not stop taking their medications before speaking with their doctors.
  • Patients should contact their doctors immediately if they experience hallucinations or if they feel overwhelmed by – and incapable of dealing with – daily life.

The Prognosis for Psychotic Depression

The prognosis for people experiencing psychotic depression is extremely positive.  The available treatments are highly effective, and most patients recover within 12 months.

Psychotic symptoms in particular respond well to treatment.  If there is a recurrence after treatment, it is the symptoms of depression rather than psychosis that are likelier to recur.

Even though all prescription medications have potential side effects, patients tolerate the more recent anti-psychotic medications much more readily than previous drugs.  Electroconvulsive therapy otherwise known as ECT may be used if patients do not respond well to drugs.  Researchers are also in the process of developing and studying the effectiveness of other treatment options.

Individuals who are suffering from psychotic depression should be reassured that medical professionals will work with them and their disorder in a non-judgmental and sympathetic manner.  It is important that they are entirely forthcoming about the extent of their symptoms so that proper treatment protocols can be undertaken.

People with psychotic depression are not alone, and they do not have to suffer unnecessarily.  Effective treatment is available and the treatments for psychotic depression are usually very successful.


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