All About Psychotic Depression

Psychotic depression, aka major depressive disorder with psychotic features, occurs when you live with major depressive disorder and experience psychosis.

If you live with this condition, you might experience psychosis no matter the severity of your major depressive disorder. It was once thought that psychosis could be experienced only with severe depression, but researchers have since learned that’s not always the case.

Psychosis might occur in the form of hallucinations or delusions — seeing things that others don’t or believing things that aren’t true.

For someone with psychotic depression, the psychosis could have a theme that corresponds with their depression, such as delusions of guilt or illness. In these cases, it’s not uncommon for the person to not be aware they‘re having a depressive episode and often insist their delusional guilt is real.

Often, it‘s a challenge to distinguish between psychotic depression and schizophrenia.

Depression is common among people with schizophrenia. While depressive disorder affects about 40% of people with schizophrenia, up to 80% experience a depressive episode during the early stages of schizophrenia.

There are many potential causes of major depressive disorder and psychosis. Although there’s no one reason you might have these experiences, background and biology could play a role.

Factors that could contribute to depression include:

• Brain chemistry. Some biological processes in the brain could make depression more likely.
• Genetics. If someone in your family lives with depression, you might also be more likely to experience it.
• Personality traits. People whose outlook is more pessimistic, are prone to stress, or have feelings of low self-esteem could experience depression.
• Environment. Living through violence, abuse, neglect, or challenging economic conditions could lead to depression.

Factors that could contribute to psychosis include:

• Genes. There could be a genetic basis for experiencing psychosis.
• Trauma. Living through a traumatic event, such as assault or war, could lead to psychotic experiences.
• Use of substances. People who are already susceptible to psychosis might be more likely to have an episode if they use substances like amphetamines, LSD, or marijuana.
• Injury or illness. Some physical injuries could cause psychosis, such as traumatic brain injury, brain tumor, or stroke. Illnesses such as Alzheimer’s might also have psychotic features.
• Mental health condition. Psychosis could be a symptom of mental health conditions such as schizophrenia.

Not knowing the exact cause of major depressive disorder or psychosis doesn‘t mean that treatment isn‘t possible. There are ways of getting help.

Symptoms of psychotic depression can look different from person to person but would involve a combination of major depression symptoms and psychosis symptoms.

The possible symptoms include:

• an inability to focus
• sleeping too much or too little
• overeating or eating too little
• no longer finding enjoyment in favorite activities
• expressing hopelessness or sadness

If you‘re experiencing hallucinations or delusions, you might have unshaken beliefs in things others don‘t or experience visions, voices, or sensations of things that aren‘t there.

If you have psychotic depression, you might not distinguish reality from delusion. Often, those around you are the first to spot the symptoms.

If you or someone you know notices symptoms of psychotic depression in you or a loved one, consider reaching out to a mental health professional for help and guidance.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), major depressive disorder is diagnosed with the presence of at least five of the following:

• depressed or low mood that is persistent or ongoing
• anhedonia or not being able to feel pleasure
• feelings of personal guilt or worthlessness
• low energy or lack of energy
• inability to concentrate
• changes in appetite
• inability to sit still or movements or thoughts that are slow
• sleep problems
• suicidal thoughts or feelings

A diagnosis of major depressive disorder requires that either low mood or anhedonia be one of the 5 symptoms and that they’re present for at least 2 weeks.

Psychosis is often understood as a symptom and not a stand-alone diagnosis.

Psychotic depression treatment depends on how the two main features of the diagnosis relate to one another. A healthcare or mental health professional would first try to determine whether the psychosis is a symptom of severe depression or if the psychosis is a stand-alone experience.

If psychosis is present, antipsychotic medications might be suggested. If it‘s determined that you‘re experiencing paranoia or nonpsychotic delusions or obsessions as a symptom of your depression, antidepressant medications alone might help.

Cognitive behavioral therapy — a type of psychotherapy — could be recommended in conjunction with medications.

If you‘re living with psychotic depression, there are many techniques you can try to help manage your symptoms.

• Journaling. Try documenting life events, mood, diet, and sleeping patterns before or during a psychotic episode. This can help to recognize potential triggers.
• Develop a crisis plan. A mental health crisis plan is usually made before a crisis occurs to make sure you have support and help when you may not be able to ask for it. It could include details on how to spot a crisis, what treatment you prefer, and where to go for help.
• Connect with others. Having the support of others who might have similar experiences could help you feel less alone and give you ideas on ways to cope with your symptoms.
• Get moving. Staying physically active, spending time in nature, and participating in activities you enjoy might also be part of your self-care plan.

Psychotic depression is a treatable condition. You can get help to relieve some of the symptoms you‘re experiencing.

If you‘re not sure where to start, try the National Alliance on Mental Illness (NAMI) helpline at 800-950-6264 (NAMI). They can offer help and support and provide resources you might need where you live.

If you‘re looking for professional support, you can find a mental health professional using our search tools.