Psychotic Depression


Psychotic depression is a condition that occurs in between 15-25 percent of people who are hospitalized for depression. Not only do sufferers deal with the symptoms of depression, they also experience delusions or hallucinations. This can be a difficult illness to diagnose since the physician must consider the time line of events involved and not simply focus on the symptoms the person experiences.

Symptoms of Depression

People who are depressed may feel worthless or hopeless. Their whole world seems gray, and they may describe themselves as feeling empty inside. This shouldn't be confused with sadness or grief since the person who is experiencing those emotions is still feeling something.

Depression is also a physical illness. A person's facial appearance may change so that he appears tired all the time. Performing everyday activities may be challenging for someone who is depressed due to fatigue and a lack of stamina that may be present. A person who already gets headaches or constipation may find that these conditions are worse during an episode of depression. Chronic pain may be more of an issue as well.

Symptoms of Psychotic Depression

In addition to symptoms of depression, there are other symptoms that are associated with psychotic depression. An affected individual may also experience the following:

  • Anxiety
  • Constipation
  • Difficulty sleeping
  • Difficulty with motor skills (inability to move)

The individual may feel that other people are paying close attention to his actions or that they are out to get him (paranoid delusions). Delusions of guilt, where the individual feels like he is being punished for something from his past, are not uncommon.

A person who experiences a psychotic episode while being depressed is a little different than someone with other forms of mental illness. While a person who has schizophrenia might have episodes where he hallucinates or has delusions, he doesn't realize that what he sees or hears isn't real or that his ideas are not rational. In psychotic depression, the person may realize that these symptoms are not normal. As a result, he may try to mask the symptoms or avoid telling anyone about them. This only delays treatment.

This disorder can reoccur throughout a person's lifetime. The initial onset of symptoms usually begins somewhere between the ages of 20 and 40, and the individual may have somewhere between four and nine episodes over the course of his lifetime. In between, the person is generally able to function quite well.

Treatment for Psychotic Depression

Psychotic depression can be treated, and a hospital setting is where a person can get the help he needs. Antidepressant medications will likely be prescribed, along with antipsychotic medication. Both selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) have been used to treat this form of depression.

In some cases, electroconvulsive therapy (ECT) will be ordered. ECT is an effective way to treat this type of depression, but the treatment does carry a stigma, and it may not be used as often because of this fact. For a person who is at high risk for committing suicide, ECT may be the best treatment option. It is also a choice for people who are unable to tolerate medication well.

Recovering from this form of depression takes some time. Most people do so within 12 months, but they may need to continue to see a doctor regularly to make sure their condition remains stable. The key to getting appropriate treatment is to get the correct diagnosis first. Once the condition has been correctly diagnosed, the doctor can prescribe the right medications for the patient.

Both SSRIs and TCAs take some time before any improvement will be noticed by the patient. It may take several weeks before the symptoms of depression begin to subside. The sooner treatment is started, the sooner the recovery process will begin.

Psychotic Depression