Psychotic Depression


Psychotic depression is a mood disorder characterized by hallucinations or intense delusions of shame, guilt and/or persecution. It affects approximately 1 out of every 250 people. Psychotic depression disorder is distinguished from other forms of depression by aberrant thought patterns that put patients out of touch with reality. Patients are at higher risk for developing bipolar disorders following their initial episode of psychotic depression.

Psychotic Depression Symptoms

Delusions are more common than hallucinations with this illness, although some victims do suffer from sensory distortions. When hallucinations occur, auditory hallucinations are more frequent than visual hallucinations.

The most common symptom associated with psychotic depression is paranoia, delusional feelings of being watched and persecuted. Patients may believe they are being punished, either specifically for past actions or generally for being “bad” human beings. They perceive themselves as worthless.

Another common symptom associated with this form of psychosis is extreme hypochondria. Patients may worry obsessively that something is wrong with their bodies in the absence of any evidence that this is so.

Other common symptoms can include poor concentration, impaired cognitive functions, feelings of impending doom and an inability to take pleasure in anything.

In most patients, psychotic depression is also characterized by its episodic nature. The typical patient will experience between four and nine episodes over the course of a lifetime, with the first episode occurring between the ages of 20 and 40.

Psychotic Depression Diagnoses

The Diagnostic and Statistical Manual of Mental Disorders (DSM) has a specific set of criteria that must be satisfied before psychotic depression can be diagnosed. Depression, loss of pleasure in the activities of life, and some form of delusion or hallucination must always be present, in conjunction with three other symptoms out of a list of nine.

There is some controversy over the diagnosis, with some mental health professionals arguing that the disorder might be better termed “delusional depression.”

Psychotic Depression Treatment

Patients suffering from psychotic depression have a high suicide risk, so hospitalization is almost always indicated.

The first line of treatment is often a combination of antipsychotic drugs, and either selective serotonin reuptake inhibitors or tricyclic antidepressants. These drugs affect neurotransmitters in the brain, thereby enabling patients to perceive and organize sensory information in more wholesome ways.

Patients typically respond favorably to pharmacological interventions. However, electroconvulsive therapy may also be indicated in cases where a patient is at high risk for harming himself or herself.