woman with depression having psychosis

Depression is a common mental health disorder in the U.S. and worldwide, but psychotic depression is less known and far less common. In the U.S., around 22.5 million people report having a major depressive episode in the past year, while close to 47 million report a major depressive episode at least once during their lifetime. That’s about nine (9) percent of the adult population for past-year depression and about five (5) percent for lifetime diagnosis. In contrast the prevalence rates for psychotic depression are less than one percent for both past year and lifetime diagnosis.

For perspective, close to 280 million people report a diagnosis of clinical depression during their lifetime, which is around 29 percent of the world population of just over 8 billion people.

That makes depression and related disorders, such as bipolar disorder, some of the most common mental health disorders people experience. When symptoms of depression are mild or moderate, they’re uncomfortable, distressing, and can reduce the ability to fully engage in or enjoy many of the activities in daily life, such as school, work, and social functions. However, when symptoms of depression are severe, they can completely prevent the ability to engage in any of the activities in daily life, from the most basic, such as personal hygiene, healthy eating, and self-care, to the more complex, such as school, work, and family/social relationships.

Since the symptoms of psychotic depression can include delusion and hallucinations, people with psychotic depression often experience significant disruption. Despite the complexity of psychotic depression, effective, evidence-based treatments are available.

We’ll discuss the treatment of psychotic depression in a moment. First, however, we’ll review the basics symptoms, i.e. what to watch for if you think you, a friend, or loved one has psychotic depression.

Depressive Disorders: Quick Overview

There are several types of disorders in this general category, including major depressive disorder MDD), persistent depressive disorder (PDD), other specified or unspecified depressive disorders, premenstrual dysphoric disorder, depressive disorder due to another medical condition, and substance- or medication-induced depressive disorder.

Clinicians categorize some depressive disorders by the symptom profile, and others by their etiology, or origin and cause. Psychotic depression is in the former category. Clinicians diagnose psychotic depression by first identifying the presence of common depressive symptoms. Then, if they identify the presence of delusions and hallucinations as well, they may arrive at a diagnosis of psychotic depression.

Let’s take a look at the symptoms of depression, then the symptoms of psychosis.

Depressive Symptoms: Diagnostic Criteria

To receive a diagnosis for major depressive disorder, a patient must show at least two of the following symptoms every day for at least two weeks, and one of those two symptoms must be depressed mood or loss of interest/loss of pleasure in favorite activities:

  • Depressed/low mood most of every day
  • Decrease interest/loss of pleasure in daily or favorite activities
  • Significant gain or loss of weight
  • Significant change in appetite
  • Sleep problems: too little or too much
  • Excess movement or lack of movement noticed by others
  • Persistent fatigue
  • Lack of energy
  • Feeling worthless/hopeless
  • Excessive guilt
  • Problems with concentration and decision-making
  • Suicidality

[NOTE: Always take any suicidal behavior seriously, including any talk of suicide. If you or someone you know is at imminent risk of harm, call 911 or go to the hospital immediately. If you or someone you know is having a mental health crisis, but not at imminent risk of harm, please call he National Suicide and Mental Health Emergency Line: DIAL 988]

Those are the primary symptoms of depression. Remember the disclaimer before the list: to meet criteria for clinical depression, they must be present almost every day for at least two weeks. Feeling low over a personal or work disappointment or problem for a few days then bouncing back to a typical state doesn’t count: symptoms of clinical depression are persistent and disruptive.

Now let’s look at the symptoms of psychosis.

Psychotic Symptoms: What Are They?

The symptoms of psychosis align with the clinical definition of psychosis published by the National Alliance on Mental Illness (NAMI):

“…a disruption or impairment in an individual’s ability to differentiate between their perceptions and reality…as evidenced by delusions…[and] hallucinations.”

Delusions are thoughts, ideas, or beliefs a person has about themselves or the world that have no basis in reality and are easily disproven by commonly accepted objective facts. Clinicians identify four types of delusions: delusions of grandeur, delusions of persecution, delusions of thought, and delusions of relationship.

Among people with psychotic depression, delusions often include the following beliefs:

  • They’ve committed serious sins or crimes
  • They have secret, incurable, or shameful medical or mental health disorder
  • They’re being persecuted by external forces

Hallucinations involve seeing, hearing, smelling, tasting, or feeling things that aren’t there. Or , according to the experts at Johns Hopkins University, “an hallucination is a perception without a stimulus.” Clinicians identify four primary types of hallucinations: visual, auditory, tactile, and olfactory. However, hallucinations can appear through any of the five senses, including taste.

Among people with psychotic depression, hallucinations may include the following:

  • Hearing external voices saying derogatory/negative things about them
  • Hearing internal voices commanding them to harm/kill themselves
  • Seeing dark or frightening images/figures
  • Smelling things that are unpleasant/gross/disturbing

After reading the symptoms of psychosis and considering them alongside the symptoms of major depressive disorders, it’s clear that psychotic depression can present complications beyond those associated with typical depressive disorders. The consequences of untreated psychotic depression may include:

  • Impaired work, social, and academic performance
  • Turbulent family and personal relationships
  • Decreased ability to make meaningful, healthy social connections with others
  • Increasing isolation
  • Escalation of alcohol/drug use
  • Increased/escalating risky behavior

The symptoms are serious, and the consequences of going without treatment are significant. However, it’s important to understand that effective, evidence-based treatment is available

Treatment for Psychotic Depression

The review article “Psychotic Depression: Diagnosis, Differential Diagnosis, and Treatment” indicates the most effective treatment for psychotic depression includes a combination of psychotherapy, medication, education, and social support.

Psychotherapeutic techniques may include:

  • Cognitive behavioral therapy (CBT)
  • Interpersonal psychotherapy (IPT)
  • Psychodynamic psychotherapies
  • Family therapy

Medications may include:

  • Antidepressants
  • Antipsychotics
  • Mood stabilizers

Education may include:

  • Workshops on the science of mental health and mental health treatment
  • Communication workshops
  • Healthy relationships
  • Nutrition and activity

Social Support may include:

  • Education assistance
  • Vocational assistance
  • Housing assistance

Evidence shows that the earlier a person with a mental health disorder gets evidence-based treatment, the better the outcome. That’s why the best course of action – if you think you or someone you know has psychotic depression – is to arrange a full psychiatric evaluation administered by a qualified mental health professional.

Finding Help for Psychotic Depression

To find treatment for psychotic depression, please call us here at Crownview Psychiatric Institute. Or please take advantage of the following online resources: