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Causes, Symptoms, and Treatment of Psychotic Depression

One subtype of major depression is psychotic depression. It happens whenever a serious depressive illness includes some type of psychosis.

The psychosis can be delusions (like severe feelings of having committed a sin, intense feelings of failure, or worthlessness).

You may also experience hallucinations (like hearing a voice telling you that you’re worthless or no good), or some other break with reality.

This affects almost 1 out of 4 individuals admitted to a medical facility for depression.

Why is Psychotic Depression Different from Clinical or Major Nonpsychotic Depression?

psychotic depression

An individual who is psychotic is out of touch with reality.

That is according to the National Institute of Mental Health.

Individuals suffering psychosis might hear voices.

Often times, they might have illogical and strange ideas.

  1. For instance, they might think that other people are trying to harm them or can hear their thoughts.
  2. Or, they may think they’re wanted by the police for having committed a crime that they really didn’t commit. 

They may also think they’re possessed by a demon.

Individuals Suffering From Psychotic Depression

Individuals suffering from psychotic depression might get angry without any reason.

Also, they might spend a lot of time in bed or alone.

They sleep during the day and stay awake at night.

An individual with psychotic depression might... 

psychotic depression

... neglect appearance by not changing clothes or taking a bath. Talking to a person with psychotic depression will also be hard.

Sometimes, that person rarely talks or else says things that doesn’t make any sense.

Individuals Suffering From Other Mental Conditions

Individuals suffering from other mental conditions, like schizophrenia, also experience psychosis.  

However, people with psychotic depression typically have hallucinations or delusions.

These are consistent with themes about depression, psychotic symptoms in schizophrenia are more often implausible or bizarre.

It has no clear connection to their state of mood (for instance, believing that strangers are following them just to harass them).

psychotic depression

Some, individuals might be ashamed or humiliated of the thoughts of this. 

Because of this, they tend to hide them.

This is the reason why this form of depression is extremely hard to diagnose.

However, diagnosis is very important. The treatment is not the same as for nonpsychotic depression.

Aside from that, having one episode of psychotic depression improves the risks of bipolar disorder with recurring episodes of suicide, mania, and psychotic depression.

Causes of Psychotic Depression

The cause of this type of depression is not completely known. It is understood that there is no one cause of depression and it has a lot of various triggers.

For some people, live events that are stressful can be the cause. These events include financial worries, serious illness, divorce, or bereavement.

Genes may possibly have a role since severe depression can run within a family.

However, it isn’t known why several individuals also develop psychosis.

A lot of individuals with psychotic depression...

psychotic depression

... may also have experienced adversity during their childhood, like a traumatic event.

​​​​Symptoms of Psych​​​​otic Depression

Having episodes of psychosis means that the person is experiencing delusions and hallucinations.

Delusions are beliefs or thoughts that aren’t probably true. On the other hand, hallucinations are tasting, seeing, smelling, feeling, and hearing things that are not there.

One common hallucination is hearing voices.

psychotic depression

Another symptom of psychotic depression is psychomotor agitation.

This means that the person is not able to sit still or relax.

He or she is fidgeting constantly.

In some severe conditions, an individual with psychotic depression might have psychomotor retardation.

This means that his or her physical movements and thought slow down. People suffering from psychotic depression have a high risk of thinking about suicide.

Here are some other common symptoms for people who are suffering from psychotic depression:

  • Delusions or hallucinations
  • Physical immobility
  • Intellectual impairment
  • Insomnia
  • Hypochondria
  • Constipation
  • Anxiety
  • Agitation

How to Treat Psychotic Depression

Typically, treating people with psychotic depression is given in a hospital setting.

With this, the person has close monitoring by mental health experts.

To stabilize the mood of a person, various medications are utilized.

Usually, it includes combinations of antipsychotic medications and antidepressants.

Antipsychotic medications affect neurotransmitters that enable communication between nerve cells in parts of the brain.

These areas regulate our ability to organize and perceive information about the world around us.

Today, there is a lot of neuroleptic or antipsychotic medications commonly used.

These include asenapine, cariprazine, aripiprazole, quetiapine, olanzapine, and risperidone.

Every drug has special side effects and might differ in its clinical efficacy profile.

Though, these drugs typically are better tolerated than earlier antipsychotics.

Treatment for psychotic depression involves:

  • Social support: support with social needs, such as accommodation, employment, and education.
  • Psychological therapies: the one-on-one conversational therapy. Cognitive Behavioral Therapy (CBT) has proved efficient in helping some individuals with psychotic depressions.
  • Medication: a combination of antidepressants and antipsychotics can help relieve the symptoms of psychotic depression.

Often times, electroconvulsive therapy might be suggested if the individual has serious depression.

This may also be recommended if other treatments, such as antidepressants, have not worked.

Generally, treatment is effective. However, it still requires follow up appointments so that the individual can be monitored closely.

Does Treatment for Psychotic Depression Always Effective?

psychotic depression

Treating psychotic depression through mental health professionals is extremely effective.

Individuals are able to recover. It typically takes several months. 

However, constant medical follow-up might be required.

Often times, electroconvulsive therapy, also known as ECT, is utilized if the medications don’t work to end the depression and psychosis.

  1. It is significant for the person with psychotic depression to work with the mental health professional to find the most effective drugs with the least side effects.
  2. The risk of suicide is also great for psychotic depression is pretty serious.
  3. If you know a person suffering from psychotic depression, you should not wait until it becomes very serious.
  4. Treating it early will be very effective. If the person has thoughts of harming others or killing him/herself, go to a hospital emergency room or call 911.

Also, you can call the National Suicide Prevention Lifeline. They have trained professionals available to talk to you 24/7.

About Rob

Get some of my advice on how to deal with different anxiety issues, from my own personal experiences. I have learned several different treatments that can help you with your own anxiety disorders.

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