How Psychotic Depression Is Different and When It Can Happen

Ph.D., CPsychol., AFBPsS, Health Professional
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The terms neurosis and psychosis are key to understanding several important mental health references, including psychotic depression. Most people experience some form of neurosis (mild mental illness not caused by a disease) as part of the human condition. Unless neuroses are especially severe, such as anxiety or stress, they tend not to impair normal, everyday functions. Psychoses, however, refer to mental states that impair thoughts, perceptions, and judgments. A person who experiences a psychotic episode may hallucinate, become paranoid, or hold on to beliefs that are unlikely to be true.

Psychotic depression is a severe form of clinical depression that comes with symptoms more commonly associated with psychosis. A person with psychotic depression may hallucinate by seeing, hearing, smelling, feeling, or tasting things that aren’t there. The most common form of hallucination is hearing voices. A psychotic episode may also include delusions. Delusions are fixed and unshakable beliefs, even in the face of evidence to the contrary.

The National Alliance on Mental Illness (NAMI) states that symptoms of psychosis are experienced in one in five people with major depression. Although the cause of psychotic depression is unknown, researchers think there is a genetic component for some people.

How psychosis links to depression

A key characteristic of psychosis is that it exaggerates some of the symptoms already seen in major depression. For example, common symptoms of depression revolve around a sense of worthlessness and guilt. A person with psychotic depression may believe they are completely to blame for some terrible event, accident, or crime. They are also more likely to contemplate suicide because of these beliefs.

One of the problems with diagnosing psychotic depression is the shame that comes with such delusions. This means sufferers are inclined to keep their thoughts to themselves, which can result in increased agitation. So-called “psychomotor agitation” is another symptom of psychotic depression; a person fidgets, finds it hard to sit still, and may rock or move their legs a lot. Conversely, a person may be so overwhelmed by their emotions and beliefs that they suffer psychomotor retardation; they look as if their body is heavy, they speak slowly, and they move very slowly — so slowly that they may become immobile.

Treatment

A combination approach of psychological therapy and medication is most commonly used. In very severe depression, electroconvulsive therapy (ECT) may be used, especially in cases where antidepressants appear ineffective.

Medication for psychotic depression combines antidepressants and antipsychotics. Psychological therapy, in the form of cognitive behavioral therapy (CBT), may help the patient come to terms with their condition, as well as understand and control some of their thought processes.

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Mild, Moderate or Severe Depression? How to Tell the Difference

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7 Triggers of Depression