Psychotic Depression: Symptoms, Causes & Treatment Options

A Quick Guide

Psychotic depression, also known as Major depressive disorder with psychotic features, is much more common than you think. According to some estimates, between 14.7 and 18.5 percent of individuals who suffer from major depression may also exhibit psychotic traits, and the prevalence rates may increase with increasing years. This disorder can be quite debilitating in nature though still it is commonly underdiagnosed. Still, there are effective treatment options available. In this article, we will discuss what psychotic depression is, its causes, diagnosis and treatment options.

What is Psychotic Depression?

Psychotic depression is characterized by not only depressive symptoms but also symptoms of psychosis. 

Symptoms of depression

Common symptoms of depression include the following: 

• A feeling of unworthiness
• A lack of interest in formerly interesting activities.
• A sense of helplessness or hopelessness.
• An overall lack of energy or lethargy.
• Changes in appetite.
• Difficulty focusing, making decisions, or recalling information.
• Disturbances in sleep, such as too much or too little sleep.
• Extreme sadness, anger, or irritability that lasts for a long time.
• Often having suicidal thoughts

Symptoms of Psychosis

Experiencing psychotic episodes can be very distressing and typically involves:

• A state of stupor.
• Hearing voices is a common hallucination, but other hallucinations include feeling, smelling, seeing, or tasting things that are not actually there.
• Improbable thoughts or beliefs known as delusions.

The person’s delusions and hallucinations nearly often reflect their extremely low mood; they might start to believe they’re to blame for something or that they’ve done something wrong.

In addition, psychomotor agitation is typical. This entails frequent fidgeting and an inability to unwind or sit still. On the other hand, a person with psychotic depression could experience psychomotor retardation, in which their thoughts and motions become sluggish. Those who suffer from psychotic depression are more likely to consider suicide.

Major Depression vs Psychotic Depression

Clinical depression, also known as MDD, can have an impact on your mood, behavior, daily life, and physical condition. Generally, a major depressive episode includes persistent sadness or a lack of interest in daily activities for at least two weeks, along with four or more other depressive symptoms.

The nine primary symptoms of depression do not include psychosis, and many people with MDD never develop psychosis. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition DSM-5 categorizes the two differently, referring to depression with psychotic features as Other Specified Depressive Disorders.

Depression is a serious condition. In spite of this, professionals frequently view MDD with psychosis as being more severe than depression without psychosis since it is more likely to involve:

• Melancholic features.
• Relatively severe symptoms.
• Increased likelihood of self-harm or suicidal thoughts.

What are the causes of psychotic depression?

It is unclear what exactly causes psychotic depression. It is well-recognized that depression has numerous triggers and no single causes. Some people may experience stress due to traumatic life events like death, divorce, chronic illness, or financial difficulties. Since severe depression often runs in families, genetics most likely play a role, however, it is unknown why some people also experience psychosis. Distress in childhood, such as a traumatic experience, is common among those with psychotic depression.

How is psychotic depression diagnosed?

People who are suffering from psychosis and depression don’t always seek treatment on their own. Sometimes a close relative or good friend will assist them in seeking a medical or mental health expert who can provide a diagnosis.

A mental health professional typically starts by asking you questions regarding your mental health, feelings, and emotional state in order to make a diagnosis. They could inquire about:

• Deep-rooted ideas or recurring challenges that interfere with your daily existence.
• Difficulties with eating, sleeping, or carrying out your everyday activities.
• Health issues.
• Other signs of mental illness, such as mania or anxiety.
• Things that nobody else seems to notice that you see, hear, or feel.
• Your medical, mental health, and family history.
• Your social circle and support system.

Even for experienced clinicians, psychosis is not always easy to spot right away. Some mental health specialists might not be able to tell the difference between rumination, a cycle of recurrent depressing, dark, or unpleasant thoughts, and permanent delusions right away. Rumination, a typical feature of depression, and delusions both include:

• Fear of being rejected
• Feeling that you failed as a parent or a partner.
• Guilt for supposed lapses of judgment.

It can be helpful for your clinician to make the correct diagnosis if you describe all of your thoughts, feelings, and beliefs to them.

Additional signs that support a severe depression diagnosis include:

• A major influence on a few aspects of daily life.
• Depressive state lasting for at least two weeks.
• The condition has nothing to do with doing drugs or having another illness.

What are some treatment options?

There is some disagreement over the most effective first- and second-line treatments for psychotic depression. First-line treatment tends to involve a mix of antidepressant and antipsychotic drugs, or monotherapy, which is the exclusive use of either an antidepressant or an antipsychotic. Electroconvulsive therapy ECT is normally reserved for second-line treatment, and doctors may turn to it if other drugs have failed to reduce symptoms. As an additional form of treatment for depression with psychosis, psychotherapy or talking therapies can potentially be beneficial to patients.

Medication

Combinations of antidepressant and antipsychotic drugs may be prescribed by a psychiatrist. Different antidepressants have an impact on various neurotransmitter systems. Selective Serotonin reuptake inhibitors SSRIs and Serotonin-Norepinephrine Reuptake Inhibitors SNRIs are common variations of these medications. In addition to first- or second-generation antipsychotics, doctors frequently prescribe antidepressants. According to research, using antidepressants and antipsychotics together may be more beneficial than taking just one of the two drugs.

Electroconvulsive Therapy ECT

Under the guidance of a physician, usually a psychiatrist, electrical currents are applied to a patient’s head in order to cause a generalized seizure in the brain. This method is known as Electroconvulsive therapy ECT. If a patient doesn’t improve after receiving medication-based treatment, the physician may recommend Electroconvulsive therapy ECT. For those suffering from psychotic depression, it is a secure and productive treatment.

Psychotherapy

Psychotherapy can be helpful as a supportive strategy even though it may not significantly reduce psychotic symptoms on its own. For instance, therapy provides a secure environment for discussing unpleasant feelings and experiences. A therapist could also teach you coping mechanisms for dealing with delusions and hallucinations.

Potential strategies include:

• Acceptance and Commitment Therapy
• Acceptance-based therapy for Depression and Psychosis
• Behavioral Activation
• Cognitive Behavioral Therapy

Outlook for people with psychotic depression

The long-term prognosis for depression with psychosis is favorable if patients adhere to a treatment plan. Even the most intense symptoms of psychotic depression can be controlled with medication or ECT.

Despite the fact that therapies might lessen depressive and psychotic symptoms, they can also result in adverse effects, which may include the following:

• Drowsiness.
• Dizziness.
• Difficulty sleeping also characterized as insomnia.
• Gaining or losing weight.
• Loss of short-term memory.

It is important to contact a healthcare physician as soon as possible if someone is concerned that they or someone they know may have psychotic depression. People frequently benefit from treatments and make full recoveries.

We hope you found this article useful in learning more about psychotic depression, along with its signs and symptoms, causes, diagnosis, outlook and treatment options. 

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