Understanding Psychotic Depression

Medical Reviewer

Psychotic depression, otherwise known as major depressive disorder with psychotic features, is being considered as a disorder in its own right according to a medicalnewstoday report.

There are three particular features of psychotic depression that stand apart from non-psychotic depression. The first of these are paranoid beliefs that may involve sinister notions of being monitored, tracked, followed or whispered about. Visual or auditory hallucinations may be present but more commonly delusions (false beliefs), perhaps in the form of special messages, or fearful beliefs about what is happening or about to happen. Aside from psychotic symptoms, people with psychotic depression may also exhibit higher levels of anxiety, agitation, hypochondria, insomnia and cognitive impairment (e.g. concentration, memory, reasoning problems).

Psychotic depression has tended to be regarded as relatively uncommon, or as a potential feature of depression if symptoms are especially severe. However, one of the known issues with psychotic depression is the insight to which some sufferers appear to have into their situation. Unlike a psychotic illness such as schizophrenia where insight is lacking, people with psychotic depression often hide their experiences because they know them not to be true. This probably masks the true extent of the condition and may even make treatment less effective.

According to Grace Rattue's article in Medical News Today, there remains some dispute over whether psychotic depression should be considered a distinct diagnostic category at all. One reason for this is its low diagnostic stability. The validity of psychiatric diagnosis hinges upon stability of diagnosis over time, so the more stable the diagnosis, the more likely it is to reflect a consistent process. However, those promoting a change in diagnostic practices make the case that the disorder is already sufficiently distinct. They point, for example, to higher mortality rates, a strong hereditary component, a higher risk of developing bipolar disorder and differences in treatment response and prognosis.

At present the treatment of psychotic depression involves combinations of antidepressant and antipsychotic medications. If these are ineffective then electroconvulsive therapy (ECT) may be considered. This is generally very effective. In terms of prognosis, most people with psychotic depression show good recovery within a year and if symptoms to return they are often more likely to be depressive than psychotic.