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Major Depressive Disorder With Psychotic Features

Reviewed by: HU Medical Review Board | Last reviewed: October 2023

Major depressive disorder (MDD) is the most common mental health condition in the United States. In some cases, depression can come with an added layer of complexity known as psychotic features.1

MDD with psychotic features is also known as psychotic depression. People with this condition experience severe depression along with psychosis. Psychosis is a mental state in which a person loses touch with reality.2,3

Who gets MDD with psychotic features?

This condition can affect people of all ages, genders, and backgrounds. The average age of onset is late 20s, but the condition is not limited to a particular group. However, it is rare compared to other types of depression.2

According to some studies, women are more at risk of developing MDD with psychotic features than men. People with a family history of mood disorders, like bipolar disorder, have a greater risk as well.2,3

What causes MDD with psychotic features?

The exact causes of depression with psychotic features are not fully understood. Experts believe the following factors may play a role:4,5

  • Imbalances in brain chemicals responsible for regulating mood
  • Family history of mental illness
  • Chronic stress and/or trauma
  • Structural differences in the brain
  • Medicine or substance use

What are the symptoms of MDD with psychotic features?

The hallmark of depression with psychotic features is that depression and psychotic symptoms occur together.

Depressive symptoms include:2,3

  • Persistent sadness
  • Feelings of hopelessness
  • Loss of interest in activities
  • Changes in appetite or weight
  • Sleep problems (inability to sleep or oversleeping)
  • Fatigue and low energy
  • Difficulty concentrating
  • Suicidal thoughts or behaviors

Psychotic symptoms include:2,3

  • Seeing or hearing things that are not there (hallucinations)
  • Strongly held false beliefs (delusions)

These symptoms can disrupt how a person functions day to day. And they can increase the risk of self-harm. This makes early diagnosis and treatment crucial.3

How is MDD with psychotic features diagnosed?

Diagnosing MDD with psychotic features requires evaluation by a mental health professional. During this evaluation, they ask about a person’s medical history and symptoms. A diagnosis typically also involves the following in order to rule out other conditions:2,3

  • Physical exam
  • Mental health assessment
  • Questions about family history of mental health disorders
  • Blood tests
  • Other lab work such as urine tests or brain scans

How is MDD with psychotic features treated?

Psychotic depression can be dangerous if left untreated. Thankfully, there are several treatments available for this condition.3,4

The goal of treatment for MDD with psychotic features is remission. Remission means that symptoms go away or are reduced to a manageable level. Treatment may involve a combination of:3,4

  • Medicine – Antidepressant drugs, along with antipsychotic drugs, can help relieve depressive and psychotic symptoms.
  • Psychotherapy – Supportive talk therapy can help people manage their depression and learn to cope with psychotic symptoms.
  • Electroconvulsive therapy (ECT) – In severe cases where other treatments have not worked, ECT may be used. In ECT, electrical pulses delivered to the brain cause controlled seizures. This may provide relief from symptoms.
  • Lifestyle changes – Maintaining a healthy lifestyle that includes regular exercise, a balanced diet, and stress management can help medical treatment work better.
  • Inpatient treatment – People who have severe symptoms or an increased risk of self-harm or suicide may need short-term hospitalization. In a hospital, they can receive intensive treatment and support.

Other things to know

MDD with psychotic features can sometimes be misdiagnosed. This may be because a person does not realize they have symptoms. Or they may hide their symptoms from others. If you are a caregiver or loved one of someone who may have psychotic depression, consider going with them to their doctor’s appointments. You might be able to provide helpful information to the provider.1

People who have MDD with psychotic features are at greater risk of self-harm and suicide than the general population. If you or someone you know is having symptoms of depression with psychosis, do not delay in getting help. Call or text 988 to reach the 988 Suicide & Crisis Lifeline.2

Depression with psychotic features is a challenging and often misunderstood condition, but it is treatable. Early diagnosis and the right treatment can improve quality of life for those affected by this condition. Remember, you are not alone, and there is hope for remission.

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