Psychotic Depression

Symptoms

Someone with depression feels sad and hopeless for most of the day, practically every day, and has no interest in anything. Getting through the day feels almost impossible.

Other typical symptoms of depression may include:

• fatigue (exhaustion)
• disturbed sleep

• changes in appetite

• feeling worthless and guilty
• being unable to concentrate or being indecisive

• thoughts of death or suicide

Symptoms of psychosis

Having moments of psychosis (when people lose some contact with reality) means experiencing:

• delusions – thoughts or beliefs that are unlikely to be true

• hallucinations – hearing and, in some cases, feeling, smelling, seeing or tasting things that are not there; hearing voices is a common hallucination

The delusions and hallucinations almost always reflect the person's deeply depressed mood – for example, they may become convinced they're to blame for something, or that they've committed a crime.

"Psychomotor agitation" is also common. This means not being able to relax or sit still, and constantly fidgeting.

At the other extreme, a person with psychotic depression may have "psychomotor retardation", where both their thoughts and physical movements slow down.

People with psychotic depression have an increased risk of thinking about suicide.

Causes

The cause of psychotic depression is not fully understood. It's known that there's no single cause of depression and it has many different triggers.

Genes probably play a part, as severe depression can run in families.

Life events and personal circumstances can be the cause for some people. This can include bereavement, relationship problems, financial problems, health problems and recent or past traumatic experiences.

It's not known why some people with severe depression also develop psychosis.

Treatment Options

Treatment for psychotic depression involves:

• medicine – a combination of antipsychotics and antidepressants can help relieve the symptoms of psychosis
• talking therapies – the 1-to-1 talking therapy cognitive behavioural therapy (CBT) has proved effective in helping some people with severe depression, including those with psychosis
• social support – support with social needs, such as education, employment or accommodation

The person may need to stay in hospital for a short period of time while they're receiving treatment.

Electroconvulsive therapy (ECT) may sometimes be recommended if the person has severe depression and other treatments, including antidepressants, have not worked. 

When To See A Doctor

People with psychosis are often unaware that they're thinking and acting strangely. If you're concerned about someone and think they may have psychosis, contact a doctor.