Psychological disturbances or illnesses tend to modify or alter the way people perceive themselves and their environment. Sometimes this distortion can be so severe that a condition like depression ends up having symptoms of psychosis.

This is what happens with psychotic depression , a rare subtype of depression that we will talk about throughout this article and that can appear in people who have already been affected by several episodes of major depression.

What is psychotic depression?

Psychotic depression, also known as depressive psychosis, is a subtype of depression that occurs when severe depression includes within its symptom picture some form of psychosis . According to statistics, this type of psychotic depression usually affects approximately one in four people who are admitted to hospital with a diagnosis of depression.

Psychosis in depression can manifest itself through hallucinations of any kind, such as voices telling the person that he or she is worthless; delusions in the form of intense feelings of worthlessness and failure; or directly causing the patient to make a total break with reality.

As we can see, despite the fact that they are symptoms of a psychotic illness, the content of these symptoms is strongly related to some of the features of depression , such as low self-esteem .

Although psychotic depression is a diagnostic term in itself, it can also occur in the context of bipolar disorder or major depressive disorder. In addition, because of its similarities, it’s most commonly confused with schizoaffective disorder. However, this diagnosis requires the presence of purely psychotic symptoms for at least two weeks. That is, no depressive or mood symptoms.

As for unipolar psychotic depression, requires that the psychotic symptomatology be manifested only during episodes of major depression . The diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) indicate that, for the correct diagnosis of psychotic depression, the patient must meet the requirements for a major depressive episode, together with the criteria for the specifier of “psychotic characteristics”.

How is it different from other psychoses?

Traditionally, it is understood that a person suffering from some kind of psychosis is a person who is out of touch with reality. These patients may hear voices or present strange and illogical ideas , among many other symptoms.

When these symptoms are part of a diagnosis of psychotic depression, they usually involve behaviours such as angry and upset moods for no apparent reason, sleeping during the day to stay awake all night, neglecting their body image and hygiene and even difficulties in communicating with other people .

On the other hand, people suffering from other types of mental illness, such as schizophrenia, also experience psychotic symptoms. In psychotic depression, however, the delusions or hallucinations are consistent with the claims of depression. Whereas the content of psychotic symptoms in schizophrenia is often bizarre and implausible and has no apparent relationship to a state of mind.

In addition, in psychotic depression patients often feel ashamed of their thoughts, so they try to hide them. Hence, this type of depression is a little difficult to diagnose. Nevertheless, an accurate diagnosis is very important , since, in addition to influencing the treatment, episodes of psychotic depression are a risk factor in the development of a bipolar disorder with recurrent episodes of psychotic depression, mania and even suicide.

What symptoms do you have?

People with psychotic depression experience the symptoms of a major depressive episode, including feelings of hopelessness, worthlessness or guilt, constant fatigue, social withdrawal and agitation and irritability; accompanied by one or more psychotic symptoms including delusions and hallucinations. The patient may also have any of the following symptoms

  • Severe anhedonia.
  • Psychomotor delay .
  • Anxiety.
  • Constipation.
  • Hypochondria.
  • Insomnia .
  • Physical immobility.

What are the causes?

Although it has not been determined at this time what exactly triggers the development of psychotic depression, it has been observed that psychotic symptoms tend to develop after a person has gone through several episodes of depression without psychosis. Also, once these psychotic symptoms appear, they tend to reappear in each future depressive episode .

It has also been noted that families in which one of the family members has experienced psychotic depression are at increased risk for both psychotic depression and schizophrenia. This points to a possible genetic component to this illness.

A large number of patients with psychotic depression report experiencing an initial episode of depression between the ages of 20 and 40. As with other types of depression, psychotic depression is also usually episodic, with symptoms appearing over a certain period of time and diminishing over time. In addition, these people tend to function well both socially and professionally between depressive episodes .

Finally, while psychotic depression may be considered chronic when it lasts for more than two years, most depressive episodes last less than 24 months.

What is the treatment and prognosis?

Treatment of psychotic depression is usually carried out in a hospital setting, so that the patient can be monitored to ensure maximum safety.

A pharmacological treatment accompanied by psychological therapies is usually carried out to facilitate the integration of the patient into his or her environment. In pharmacological treatment, combinations of antidepressants and antipsychotic drugs are usually used.

While antidepressants promote mood stabilization, antipsychotics allow the brain to be able to perceive and organize information from the environment around the person.

Proper treatment for psychotic depression can be truly effective, even to the point of allowing the patient to recover within several months. However, due to the episodic nature of the illness , continuous medical monitoring is necessary .

In the most severe cases or those that do not respond to drug treatment, the application of electroconvulsive therapy may be necessary.

As for the prognosis of this disease, it tends to be much more positive than other psychiatric diagnoses such as schizoaffective disorders. Even so, people who experience a psychotic depressive episode are more likely to relapse and commit suicide . Hence the need for a close follow-up.