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What You Should Know about Depression with Psychosis

Depression, or major depressive disorder (MDD), is a common mental health condition. MDD is an overarching term that includes several types of depression. One rare but serious type of MDD is depression with psychosis. This is also called psychotic depression.1,2

What is psychotic depression?

Psychotic depression is a type of MDD. It includes the features of MDD, with the addition of psychosis symptoms. Psychosis symptoms affect the mind and can impact people in different ways. In general, psychosis symptoms show a loss of contact with reality. People often struggle to recognize what is real and what is not.1,3

Compared to MDD, people with psychotic depression are more likely to also have anxiety disorders. Symptoms of psychotic depression also last longer than other types of depression. Having psychotic depression makes you more likely to develop conditions like schizophrenia or bipolar disorder.3

We do not know why some people develop psychotic depression. However, a family history of depression or psychotic illness can make it much more likely.3,4

Some researchers believe that psychotic depression has become rarer as MDD treatment has become better and more common. The early and effective treatment of MDD may prevent it from developing into psychotic depression.2

Symptoms of psychotic depression

People with psychotic depression have symptoms of both depression and psychosis. Symptoms of psychosis include:1,2

  • Delusions – strongly held beliefs that are not based in reality
  • Hallucinations – seeing, hearing, or feeling the sensation of something that is not there

Symptoms of depression include:1

  • Feeling sad and hopeless
  • Feeling anxious
  • Loss of energy or interest
  • Feeling guilty or unworthy
  • Feeling irritable or angry
  • Unusual changes in sleep or eating habits
  • Physical aches and pains

The delusions and hallucinations may be related to depressed or anxious thoughts. For example, people may hear negative voices criticizing them. Or they may start to believe bad things about themselves based on anxious thoughts.4

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How is psychotic depression diagnosed?

It is important to get medical attention as soon as possible if you experience delusions or hallucinations. A doctor will typically use a physical exam or questionnaire to diagnose psychotic depression. They may use tests or imaging to rule out other conditions.1,4

Treatment for psychotic depression

You may need more than one treatment to manage psychotic depression. Typically, the depression is treated with an antidepressant. The psychotic symptoms are treated with an antipsychotic drug. For some people, the antipsychotic drug might not work. In this case, you may be treated with electroconvulsive therapy (ECT).1,4

In ECT, electrodes on the scalp send electric signals through the brain. These signals excite the brain and induce seizures. It is thought that the seizures help the brain rewire itself. This rewiring can help manage symptoms.1,4

The risk of attempting suicide is much higher for people with psychotic depression than for those with MDD. If you have thoughts of suicide, you may need to stay in a hospital. There is also a possibility that you could be a risk to others. In this case, you would also need to be in a hospital.4

If you or someone you know shows or has signs of psychosis, get help as soon as possible. Depression with psychosis is very serious. But with the proper treatment, it can be managed.4

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