Psychotic Depression

Psychotic depression, also called delusional depression or major depression with psychotic features, is the name given to the condition when a person has conditions of both major depression and psychosis. Keep reading for more info on psychotic depression.

Psychotic depression is a serious condition that deserves immediate medical treatment to prevent the person experiencing it from hurting him- or herself or others. This article will explain what psychotic depression means, enumerate the symptoms, and discuss treatment.

What Is Psychotic Depression?

Mental illnesses are not always separate and distinct. Sometimes, they occur at the same time. Just as you can have a broken arm and chicken pox, it’s possible to experience a major depression and have a co-existing psychosis. Let’s examine each portion.

            Major Depressive Disorder

Major depressive disorder, also called clinical depression or unipolar depression, is a serious form of depression in which a person feels sadness, loss of interest in life and activities, difficulty thinking and making decisions, fatigue, hopelessness, and - on occasion - thoughts of self-harm or suicide. Changes in eating and sleeping behavior are also common, as is a sense of being worthless.


Psychosis is a mental disorder in which a person loses contact with reality, or experiences a distorted version of reality. Psychosis can either involve believing in things that aren’t true, called delusions, or experiencing things that aren’t real, called hallucinations. A person with a psychosis might hear voices, believe that s/he were somebody else, or have paranoid thoughts.

There are several different types of psychosis.

  • Brief psychotic disorder is a short episode of psychotic behavior, often lasting less than a month, and usually occurring after some notable stress.
  • Delusional disorder involves delusions that are viable and last at least a month.
  • Paraphrenia is a type of schizophrenia that is specific to an older population.
  • Psychotic disorder due to a medical condition is a specialized type of hallucinatory or delusional disorder that can have a physical origin, such as a brain tumor or head injury.
  • Schizoaffective disorder is an illness in which people exhibit symptoms of both schizophrenia and a mood disorder, which could either be bipolar disorder or major depression.  (See below for how this differs from psychotic depression.)
  • Schizophrenia is a psychosis that lasts longer than six months and includes changes in behavior and often hallucinations and delusions.
  • Schizophreniform disorder is an illness like schizophrenia that lasts between 1 and 6 months. Thus, its duration is in between that of a brief psychotic disorder and schizophrenia.
  • Shared psychotic disorder is an illness in which a person develops delusions in relationship to another person who is already delusional.
  • Substance-induced psychotic disorder is a condition brought on by the use of or withdrawal from substances that can cause hallucinations or delusions.

In a major depression with psychotic features, the person has features of psychosis but without actually having one of the psychoses listed above. One key difference, according to experts, is that people with psychotic depression often know that their hallucinations and delusions are not true.

Symptoms of Psychotic Depression

Besides the symptoms of depression, the symptoms of major depression with psychotic features will chiefly be hallucinations or delusions. Hallucinations may occur with any of the senses: they may involve feeling that one is seeing, hearing, smelling, tasting, or something when, in fact, the thing sensed is non-existent. Delusions are false beliefs that are held in the face of rational explanations and disproving data.

Other symptoms that may or may not appear in a particular case of major depression with psychotic features include: thoughts that are confused, speech that is disorganized or impossible to understand, and detachment with a lack of emotion. The person may also experience hypochondria, unwarranted anxiety about his or her health, agitation, or constipation.

Treatment of Psychotic Depression

Using an antidepressant combined with an antipsychotic drug is usually the first type of treatment, with electroconvulsive therapy (ECT) being a back-up for effective treatment of psychotic depression. Treatment is often provided in a hospital setting. Medication is sometimes continued past the time when the patient has regained his or her normal mental state to preclude a reoccurrence.

Related Article: Reactive Depression >>