Understanding Psychotic Depression

There are now many effective treatments available today for psychosis, as well as depression.
There are now many effective treatments available today for psychosis, as well as depression.

The word "psychosis" can stir to mind images ranging from a crime-drama plotline to, perhaps, an expert's commentary on an Investigation Discovery show. But the day-to-day struggles of someone with psychotic depression are much less sensational than those of psychologically troubled people on TV -- and almost never criminal.

In fact, psychosis in general rarely leads to violence [source: Kirn]. What the disorder can cause, however, is a great amount of confusion and suffering on the part of the person who has it -- as well as his or her loved ones.


Both depression and psychosis can occur as standalone disorders, or as symptoms of another illness. For example, depression can be a symptom of bipolar disorder; whereas psychosis can accompany schizophrenia. However, when major depression and psychosis coexist outside of other conditions, it's called psychotic depression.

Despite the fact that depression is a fairly common mental health disorder, the likelihood that it would be present with psychosis is much slimmer. In fact, only about 15 percent of people with major depression exhibit the primary signs of psychosis: hallucinations and delusions [source: Croft].

As a team, depression and psychosis can be particularly harmful -- putting their victims at risk for alienation, reduced quality of life, hospitalization and even suicide. And while psychotic depression is not a common mood disorder, it accounts for more than a quarter of all hospital admittances for depression [source: WebMD].

Even though psychotic depression is a serious problem, the news isn't all bad. Most people with the condition can expect to recover from the depression and the psychosis. And new studies in brain imagining suggest that computer analysis of brain scans may be able to help doctors predict the severity of psychotic episodes, allowing for better, more customized treatments [source: Kelland].

To better understand psychosis and other symptoms related to psychotic depression, keep reading.


Symptoms of Psychotic Depression

Imagine you wake up one morning believing you're President of the United States. Perhaps the next day you think you're an undercover spy. No, these aren't the playtime imaginings of a young child; they're the delusions of a person who has experienced a break from reality.

The primary symptoms that differentiate psychotic depression from typical depression are hallucinations and delusions. A delusion is believing something that, in reality, isn't true -- like being the President or a spy. Hallucinations, on the other hand, are imaginary voices or visions. In the film, "A Beautiful Mind," (this would be your spoiler alert), the roommate, Charles, was one of main character John Nash's hallucinations.


Unlike John Nash, who was schizophrenic, a person with psychotic depression likely realizes what he or she is experiencing isn't real. While there's value in this awareness, it can also lead to feelings of shame and embarrassment. And when a person hides his or her symptoms of psychotic depression, it can increase his or her likelihood of not getting a proper diagnosis or treatment.

Of course, hallucinations and delusions aren't the only symptoms of psychotic depression -- anxiety, hypochondria, intellectual impairment, agitation, insomnia and physical immobility can be signs as well. These will be accompanied by symptoms of depression, which the Mayo Clinic reports, can include:

  • Sadness
  • Irritability
  • Loss of joy or pleasure
  • Reduced sex drive
  • Changes in appetite
  • Fatigue and tiredness
  • Chronic pain with no obvious cause
  • Feelings of worthlessness
  • Frequent crying
  • Thoughts of death

Keep reading to find out more about the causes of psychotic depression.


Causes of Psychotic Depression

Here's a quick quiz for you: Faulty neurotransmitters, such as serotonin, dopamine and norepinephrine, are the causes of depression -- true or false? If you answered "true," you've probably had some experience with antidepressants -- or, perhaps, you've watched one too many pharmaceutical commercials.

While most modern antidepressants are designed to interact with these brain chemicals -- and many have done so with successful results -- scientists still aren't sure of the exact causes of clinical depression. So, it should be no surprise that the roots of psychotic depression are also unknown. There are, however, certain risk factors that make a person more susceptible to developing the disorder. Family history of psychotic depression can increase a person's odds of developing it. According to the Mayo Clinic, risk factors for depression, in general, include:


  • Personal or family history of depression and/or substance abuse
  • Female gender
  • Low socio-economic status
  • Traumatic childhood
  • Stressful life events
  • Isolation
  • Negative outlook and behaviors
  • Life-threatening chronic illness

If a person is experiencing psychosis only, there's a chance that another psychological disorder is behind his or her delusions and hallucinations. Schizophrenia, bipolar disorder and substance abuse are also known causes of psychosis.

Fortunately, there are many effective treatments available for psychosis as well as depression. We'll explore those therapies in the next section.


Psychotic Depression Treatments

Pioneering 20th century psychologist Rollo May believed that depression is, essentially, the inability to build or conceive of a future [source: Jones-Smith]. For someone who has psychotic depression, that philosophy might apply with an even heavier force. A person who experiences both major depression and psychosis is seemingly stuck in a dark, confusing present with no way out. This is likely why depressives with psychosis are at a higher risk of suicide than are those without [source: MedlinePlus]. But while it might not feel like it to the person with the disorder, there are ways out of psychotic depression and into a brighter future.

People who have psychotic depression are usually given a combination of antidepressants and antipsychotics. Frequently prescribed antidepressants include fluoxetine, fluvoxamine, citalopram, escitalopram, paroxetine or sertraline; common anti-psychotic medications are risperidone, olanzapine, quetiapine and ziprasidone. All of these drugs carry side effects, and it sometimes takes a little bit of experimentation (with the help of a doctor) to find the ones that work best for a particular person. It's for this reason that doctors prefer to initially treat psychotic depressives in a hospital environment until the right combination of medication is achieved.


Antipsychotics are normally necessary for just a short period of time. However, most doctors recommend that someone with major clinical depression take antidepressants on an ongoing basis. If medications aren't effective, electroconvulsive therapy (ECT) may be considered as a treatment. Fortunately, drugs are usually successful at treating psychotic depression, and are considered the first-line of treatment.

Psychotic depression requires ongoing monitoring. Even though most people can expect to recover from it, continued treatment can help prevent recurrences of the disorder.

For lots more information on mental health, visit the links and resources on the next page.


Lots More Information

Related Articles

  • American Academy of Child and Adolescent Psychiatry. "Psychosis." (Jan. 16, 2012) http://www.aacap.org/cs/root/resources_for_families/glossary_of_symptoms_and_illnesses/psychosis
  • Croft, Harry. "Different Types of Depression." HealthyPlace. Jan. 7, 2009. (Jan. 16, 2012) http://www.healthyplace.com/depression/main/types-of-depression/menu-id-68/
  • Jones-Smith, Elsie. "Theories of Counseling and Psychotherapy: An Integrative Approach." Sage. April 29, 2011. (Jan. 16, 2012) http://books.google.com/books?id=PAXMnwLRChgC&dq=theories+of+counseling+and+psychotherapy&source=gbs_navlinks_s
  • Kelland, Kate. "Brain analysis can help predict psychosis: study." MedlinePlus. Nov. 7, 2011. (Jan. 16, 2012) http://www.nlm.nih.gov/medlineplus/news/fullstory_118427.html
  • Kirn, Timothy. "Psychosis rarely begets murder, experts say." Life & Health Library. August 2006. (Jan. 16, 2012) http://findarticles.com/p/articles/mi_hb4345/is_8_34/ai_n29287865/
  • Mayo Clinic. "Depression (major depression)." Feb. 11, 2010. (Jan. 16, 2012) http://www.mayoclinic.com/health/depression/DS00175
  • MedlinePlus. "Major depression with psychotic features." Feb. 24, 2011. (Jan. 16, 2012) http://www.nlm.nih.gov/medlineplus/ency/article/000933.htm
  • National Institute of Mental Health. "Combination Treatment for Psychotic Depression Holds Promise." Aug. 7, 2009. (Jan. 16, 2012) http://www.nimh.nih.gov/science-news/2009/combination-treatment-for-psychotic-depression-holds-promise.shtml
  • Stanford School of Medicine. "What is depression?" (Jan. 16, 2012) http://med.stanford.edu/depression/depression.html
  • WebMD. "Psychotic Depression." March 1, 2010. (Jan. 16, 2012) http://www.webmd.com/depression/guide/psychotic-depression