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Psychotic depression: The right diagnosis makes treatment possible

Posted on 05-27-15 in Behavioral Health, Mental Health

Psychotic depression: The right diagnosis makes treatment possible

About a quarter of patients who are hospitalized for major depression also experience something even more severe: psychotic depression. Psychotic depression is exactly what it sounds like – it’s a subtype of major depression characterized by the presence of both depression and psychosis. Psychosis can include hallucinations (seeing or hearing things that are not real), delusions (believing things that are not real) or any other break from reality.

People with psychotic depression experience a psychosis that is distinct from that observed in other illnesses, such as schizophrenia. Perhaps unsurprisingly, people with depression tend to experience hallucinations and delusions that confirm their negative self-worth. For instance, individuals might hear voices berating them or calling them stupid. They might experience delusions that people hate them or wish they would commit suicide. For people with psychotic depression, psychotic symptoms tend to emerge during a depressive episode and disappear when the episode is over.

Greater suicide risk

Doctors theorize that depression with psychotic features likely goes underdiagnosed; this is because people with depression might be embarrassed and hide their psychotic symptoms for as long as possible. A study in the American Journal of Psychiatry estimates that 20 percent of people with major depression suffer from psychotic symptoms as well as melancholic features. Distinguishing psychotic depression from major depression is essential, because patients with psychotic depression are at greater suicide risk due to illness severity.

Symptoms of psychotic depression include:

  • Typical signs of major depression, such as low mood, anxiety
  • Hypochondria
  • Physical immobility
  • Insomnia
  • Increased agitation
  • Paranoia
  • Delusions
  • Hallucinations

Although delusions and hallucinations are usually mood-congruent, in other words they relate to depression, sometimes psychotic symptoms can also be mood-incongruent and not appear to be depressive in nature.

A doctor’s diagnosis will confirm whether the patient is dealing with psychotic depression or another disorder that might provoke psychosis, such as bipolar or schizoaffective disorders. Before diagnosis, doctors might request urine and blood tests to confirm that the symptoms are not due to another illness. Doctors might also request an MRI or CT scan to gauge the brain’s structural integrity.

Remission is possible

Once diagnosed, patients with psychotic depression are usually treated with a mixture of antipsychotics and antidepressants. Although finding the right combination of medications might be difficult, people with psychotic depression are usually able to achieve remission, although they might need to continue medication and therapy to maintain their health.

Scientists are not sure why some people experience psychosis during depression, although they have found that people with psychotic depression are more likely to have a family history of severe mental illness than people with traditional depression. Some researchers suspect that psychotic depression and major depression might even be two different diseases; people with psychotic depression have been found to have greater activity in their endocrine system than people with major depression and also respond to different treatments. Research has indicated that psychotic depression in particular might respond to medication that mediates the endocrine system, opening up a new way to treat this complex disorder.

Both major depression and psychotic depression are serious illnesses that require early intervention and treatment. At Sovereign Health Group, patients seeking mental health treatment are provided with a variety of treatment options to best suit their needs including individual and group therapy, yoga, meditation, medication management, group therapy, equine therapy and many more. Our programs are built to help those struggling with addiction, mental health disorders and co-occurring conditions. For further questions, please contact a member of our team at 866-754-3385.

Written by Courtney Lopresti, Sovereign Health Group writer