20th Feb 2023
Psychotic depression refers to cases of clinical depression that have psychotic features. People who have depression with psychotic features experience hallucinations and/or delusions, alongside typical symptoms of depression . Psychotic depression is often treated with a combination of therapy and antipsychotic and antidepressant medications .
Psychotic depression is when a person with a depressive disorder, such as major depressive disorder or persistent depressive disorder, also experiences symptoms of psychosis.
Major depressive disorder is a mental health condition listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). One of the specifiers for major depressive disorder indicates that it can occur “with psychotic features” . Meanwhile, persistent depressive disorder is a less severe, but long-lasting, form of depression. Psychotic depression refers to a case of depression that involves psychotic features.
More specifically, a person with psychotic depression will have common symptoms of depression, as well as hallucinations and/or delusions. Delusions are fixed beliefs that a person maintains, even when the belief is clearly untrue, or they have evidence that disproves the belief. Persecutory delusions, in which a person believes someone is trying to harm them, are common. Hallucinations involve hearing, seeing, tasting, smelling, or feeling something that is not actually present in the environment .
Someone with psychotic depression will experience depressive symptoms like low mood, loss of interest in usual activities, difficulty with concentration, and feelings of fatigue, as well as symptoms of hallucinations and/or delusions .
Symptoms of psychotic depression include both symptoms of depressive disorders and symptoms of psychosis. These symptoms are described in more detail below.
Symptoms of depression include, but aren’t limited to :
Psychotic symptoms that occur with depression include, but aren’t limited to :
There is not one single cause of psychotic depression, but rather a combination of factors that increase the risk of developing the condition. Risk factors for psychotic depression may include :
Psychotic depression is diagnosed using the DSM-5. First, a patient must meet diagnostic criteria for major depressive disorder or persistent depressive disorder. A doctor or mental health professional will determine if a diagnosis is warranted after taking a complete medical history, gathering information about the patient’s social functioning, and asking about any current or recent stressors. A professional diagnosing psychotic depression may use standardized instruments to determine if depression symptoms are present.
To be diagnosed with major depressive disorder, a patient must meet the following diagnostic criteria :
To be diagnosed with persistent depressive disorder, a patient must meet the following criteria :
A depressive disorder with psychotic features diagnosis requires that a patient also show symptoms of hallucinations or delusions. When making a diagnosis, a clinician will list “with psychotic features” as a specifier. This specifier can occur one of two ways :
Depression is typically treated with medication, talk therapy, or both ; however, treating psychotic depression may require specialized methods. The most commonly recommended treatment modalities for psychotic depression are medication and talk therapy, which are described in more detail below. Patients also benefit from psychosocial therapy .
Patients with psychotic depression typically do best taking a combination of medications that includes an antidepressant treatment and an antipsychotic medicine. The combination of these two medications is more effective than either medication on its own .
Some specific medication combinations that may be effective include :
After a patient is stabilized on an antipsychotic medication for several months, they may be able to gradually taper off of it. However, patients with psychotic depression have a greater relapse risk when compared to patients who have depression without psychotic features, so it’s important to consult with your doctor before discontinuing any medication .
Electroconvulsive therapy (ECT) is also beneficial for treating psychotic depression . This form of treatment uses electrical impulses to stimulate the brain while a patient is under anesthesia. It may cause temporary side effects, such as confusion and memory loss .
Therapy methods have not been as well-studied in the treatment for depression with psychosis when compared to treatment of depression without psychotic features. Nonetheless, therapy is considered a necessary component of treatment .
The following therapies may be beneficial for patients with psychotic depression :
The answers to the following frequently-asked questions provide additional information about psychotic depression.
Psychotic features is a diagnostic specifier for major depressive disorder. is a form of major depression. Major depression is a general diagnosis in which a person experiences symptoms of depression for at least two weeks. Psychotic depression is a specifier applied to a particular form of major depression in which patients experience hallucinations and/or delusions .
Patients with schizophrenia experience symptoms of psychosis, including hallucinations and delusions, but schizophrenia is different from depression with psychotic features. Patients with depression experience other symptoms beyond hallucinations and delusions, including depressed mood, loss of interest in activities, fatigue, and suicidal ideation. These depressive symptoms are absent in schizophrenia.
With effective treatment, people who live with psychotic depression can learn to overcome the effects of their symptoms and lead healthy, fulfilling lives. However, psychotic depression is associated with a higher risk of relapse when compared to depression without psychotic features , so it’s important to stay engaged in treatment.
Treatment for psychotic depression is effective, but studies suggest that this form of depression seems to be more severe when compared to depression without psychotic features. With psychotic depression, depressive episodes last longer and more likely to reoccur .