Depression with psychotic features is when someone experiences both depression and psychosis. Psychosis refers to a disconnection from reality and may include symptoms such as hallucinations or delusions. Major depression with psychotic features is also sometimes referred to as psychotic depression. It is a grave illness characterized by a combination of unipolar major depressive symptoms and psychosis. This form of depression is an underdiagnosed and undertreated condition.
We focus here on unipolar depression, so the term major depression refers to a major depressive episode and not bipolar disorder. People must remember that psychosis is a symptom of particular mental health conditions, not a disorder in itself.
Experiencing psychosis can be frightening and confusing, and psychosis can present in a variety of ways. This article will discuss how specialists diagnose depression with psychosis, as well as outlining treatment options and steps to recovery.
What is depression with psychosis?
Psychotic depression is an underdiagnosed form of depression. Major depression is one of the most common mental health conditions in the United States. According to the National Institute of Mental Health (NIMH), an estimated 4.3 percent of adults in the United States had at least one major depressive episode in 2016.
Depression with psychosis is when a person has depression and also experiences a disconnection from reality, which is called psychosis. Experts also refer to depression with psychosis as depression with psychotic features. Major depression affects mood, behavior, and various physical functions, such as sleep and appetite.
The symptoms of major depression include:
The major symptoms of depression are loss of interest in once pleasurable activities, changes in appetite and sleep, such as sleeping too much or too little, difficulty concentrating making decisions and remembering things recurrent thoughts of death or suicide.
Psychosis means that a person feels disconnected from reality. It occurs when someone experiences things that are not reality, such as hallucinations or delusions.
Symptoms of psychosis include:
- Delusions: also known as false beliefs or false perceptions.
- Hallucinations: or seeing or hearing things that are not present.
- Paranoia: is the feeling that you’re being threatened in some way.
Diagnosing depression with psychosis changes in a person’s sleep pattern can be a symptom of depression.
Typically, a doctor will prescribe an antidepressant, antipsychotic, or a combination of both. There is some debate around the best treatment process for psychotic depression, particularly regarding first- and second-line treatments.
First-line treatment usually involves a combination of antidepressant and antipsychotic medications, or monotherapy, which refers to the use of either antidepressants or antipsychotics alone. Doctors typically reserve electroconvulsive therapy (ECT) for second-line treatment, and specialists may use it if different medications have not helped to alleviate symptoms. Psychotherapy, or talking therapies, can also help people, as a supplemental treatment for depression with psychosis.
A psychiatrist may prescribe a combination of antidepressant and antipsychotic medications. Different antidepressants affect different neurotransmitter pathways. Common forms of these drugs include serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs).
Doctors often prescribe antidepressants alongside first- or second-generation antipsychotics. Research suggests that the combination of antidepressant and antipsychotic medications is more effective than either of the two medications alone.
Some antidepressant and antipsychotic combination treatments include:
- Venlafaxine (Effexor) and Quetiapine (Seroquel)
- Sertraline (Zoloft) and Zyprexa (Olanzapine)
- Fluoxetine (Prozac) and Zyprexa (Olanzapine)
- Electroconvulsive Therapy (ECT)
Electroconvulsive therapy (ECT) is a medical procedure performed under anesthesia, in which a doctor, usually a psychiatrist, applies electrical currents to a person’s head, inducing a generalized seizure in the brain. The treating prescriber may refer a person to electroconvulsive therapy (ECT) if they do not respond to medication-based treatments. Electroconvulsive therapy is a safe and effective treatment for people with psychotic depression.
Steps to recovery
Psychosis can lead a person to hold a distorted view of what others perceive to be reality. The delusions or hallucinations associated with psychotic depression can lead to a medical emergency, which needs immediate medical attention.
A person may need to spend some time in the hospital, followed by an inpatient or outpatient treatment program.
Treatments focus on reducing or managing symptoms. Currently, no treatments can entirely cure psychotic depression. This means that people will usually need on-going treatment.
If people follow a treatment program, the long-term outlook for depression with psychosis is good. Medication or ECT can help manage even the most severe symptoms of psychotic depression.
Although treatments can reduce psychotic and depressive symptoms, they can also have side effects that may include the following:
- Trouble sleeping (insomnia)
- Weight gain or weight loss
- Short-term memory loss
If someone is worried that they or somebody they know may have depression with psychosis, they should speak with a healthcare provider, as soon as possible. People often respond well to treatments and make a good recovery.