Psychotic Depression

Psychotic depression is a complex type of depression that includes hallucinations, paranoia or delusions. Symptoms of psychosis are usually negative and self-critical.

Psychotic depression occurs in depression or bipolar disorder, but psychotic symptoms are more likely to occur in people with severe depression. Approximately 1 in 5 people living with major depressive disorder experience symptoms of psychosis. Depression that occurs in schizophrenia or schizoaffective disorder is considered a different condition.

For many people, depression starts with a sad mood or irritability as well as changes in sleep, energy or appetite. Symptoms then become more serious and can include feelings of hopelessness, helplessness worthlessness or thoughts of suicide. If a person’s depression remains untreated, symptoms of psychosis may develop. Psychotic depression can become a psychiatric emergency due to the increased risk of suicide.

What Causes Psychotic Depression?

People with psychotic depression are more likely to have other family members who are living with mental health conditions. While no specific region of the brain or gene “causes” psychotic depression, scientists have observed differences in neurotransmitters and hormones when compared with persons living with depression without psychosis.

Like other types of depression, women are more likely to experience psychotic depression than men are. 

How is Psychotic Depression Treated?

Because of the increased risk of suicide, psychotic depression often requires inpatient hospitalization for effective treatment. There are no FDA-approved treatments for psychotic depression, but two treatment options are often effective:

  • A combination of antidepressant and antipsychotic medications. These medications are usually helpful but may take up to several months before seeing their full effect.
  • Electroconvulsive therapy (ECT). In some cases, ECT can achieve life-saving results in less than a few weeks. ECT can have serious side effects, including memory loss, but it is often the treatment of choice for people experiencing serious thoughts of suicide.

While psychotherapy such as cognitive behavioral therapy (CBT) is not a recommended primary treatment for psychotic depression, it can be very helpful as a secondary treatment option. As with any other illness, you should discuss all treatment options with your psychiatrist or other mental health professional.

With effective treatment, most people with psychotic depression will experience recovery. Ongoing treatment to prevent symptoms from returning is often necessary.

The support of family and friends can also improve the chances of recovery. Empathic, non-judgmental, support and encouragement in treatment can lead to better outcomes. This support combined with proper psychiatric care can lead to sustained wellness and recovery.