Psychotic Depression: Causes and Symptoms

In certain instances, individuals grappling with severe depression may encounter hallucinations and delusional thinking. When these symptoms coexist with depression, the condition is termed psychotic depression.

Studies suggest that approximately 0.4% of adults, regardless of age, are affected by psychotic depression. However, the prevalence appears to be higher among individuals aged 60 and above, with up to 3% of this population experiencing this condition. These statistics highlight that it, although relatively rare in the general adult population, may have a greater impact on older individuals. 

Understanding the prevalence rates helps shed light on the significance of addressing this specific subtype of depression, particularly among older adults, and underscores the importance of appropriate diagnosis and targeted interventions for those affected.

What is psychotic depression?

Psychotic depression is a specific form of major depression that emerges when a severe depressive episode incorporates elements of psychosis. This psychosis may manifest as hallucinations, such as hearing derogatory voices questioning one’s value or self-worth, or delusions characterized by overwhelming feelings of worthlessness, inadequacy, or guilt. In some cases, there may be other indications of detachment from reality. 

Living with psychotic depression can be an immensely distressing experience. The hallucinations and delusions that individuals endure are deeply unsettling. It often causes feelings of extreme despair and a heightened risk of suicidal ideation. Such intrusive thoughts about death may frequently plague those affected by this condition.

According to experts, it is crucial to differentiate psychotic depression from psychosis and schizophrenia. They clarify that psychosis alone is not a standalone illness, much like how a fever is not an illness itself. Psychosis arises due to dysfunction in the brain region responsible for distinguishing internal experiences from external reality.

What are the causes of psychotic depression?

The exact cause of psychotic depression remains incompletely understood. Depression, including psychotic depression, does not stem from a singular cause but rather from a multitude of triggers. The complex nature of depression entails various factors contributing to its onset and development.

Genetics

A family history of depression, such as a parent or sibling with the condition, raises the chances of developing depression. Genetics play a role in determining one’s susceptibility to this mental health disorder.

Brain Chemistry

Imbalances in specific hormones, like dopamine and serotonin, have an impact on a range of mental health conditions, including depression and psychosis. Furthermore, there is evidence indicating that elevated levels of the stress hormone cortisol may also be involved in these disorders.

Environmental Factors

Traumatic or stressful experiences, particularly during childhood, can increase the likelihood of developing depression. These environmental factors possess the ability to influence an individual’s vulnerability to the condition.

What are the symptoms of psychotic depression?

When someone experiences psychosis, it signifies a significant disconnection from reality. In the context of psychotic depression, this detachment from reality occurs simultaneously with the primary symptoms of depression.

The symptoms commonly associated with psychotic depression include: 

  • HALLUCINATIONS: SENSE OR HEAR THINGS THAT HAVE NO BASIS IN REALITY.
  • DELUSIONS: MAINTAINING BELIEFS THAT ARE NOT SUPPORTED BY FACTUAL EVIDENCE.
  • DISORDERED AND DISORGANIZED THINKING: EXPERIENCING COGNITIVE PROCESSES THAT ARE FRAGMENTED OR LACK COHERENCE.
  • PARANOIA: EXHIBITING SUSPICION OR DISTRUST TOWARDS OTHERS, OFTEN ACCOMPANIED BY IRRATIONAL FEARS. 

In addition to the aforementioned symptoms, individuals with psychotic depression may also experience many of the fundamental signs of depression, which include: 

  • FEELINGS OF SADNESS AND HOPELESSNESS
  • ANXIETY
  • RESTLESSNESS OR AGITATION
  • EASILY BECOMING IRRITABLE OR GETTING ANGRY OVER MINOR ISSUES
  • INSOMNIA OR OTHER DISRUPTIONS IN SLEEP PATTERNS
  • CHANGES IN APPETITE LEAD TO WEIGHT FLUCTUATIONS.
  • EXPERIENCING GUILT
  • DIFFICULTY CONCENTRATING
  • NEGLECTING PERSONAL APPEARANCE AND HYGIENE
  • LOSS OF INTEREST IN PREVIOUSLY ENJOYED ACTIVITIES
  • PERSISTENT LACK OF ENERGY OR FATIGUE

The hallucinations and delusions experienced can create a deep-seated feeling of burden, causing individuals to perceive that their family and loved ones would be better off without them. This thought process holds significant power and presents a grave danger, as mentioned earlier, frequently leading to the emergence of suicidal thoughts or intentions in those affected.

Experts emphasize the significance of recognizing that hallucinations are less frequent than delusions in individuals experiencing psychotic depression. Delusions commonly associated with this condition often manifest as depressive and nihilistic in nature. 

What are the treatments for psychotic depression?

Psychotic depression can be managed by therapy near me.

Treatment for psychotic depression typically involves two main approaches. One option is to combine an antidepressant with an antipsychotic oral treatment, while the other is electroconvulsive therapy (ECT). The choice between these modalities depends on the individual’s situation and is a decision to be made in consultation with the family.

In specific situations, particularly with older patients, electroconvulsive therapy (ECT) may be favored over oral treatments to mitigate potential side effects. It is not unusual for a treatment plan to include an initial course of ECT. This is followed by the subsequent administration of antidepressant and antipsychotic oral treatments. Experts also mention the potential benefits of talk therapy but typically advise its implementation after the initiation of primary treatments such as oral treatments or ECT.

The prognosis for individuals recovering from psychotic depression is highly favorable. The occurrence of a psychotic depression episode can have a substantial impact on a person’s life. However, the duration of recovery varies from individual to individual. In most cases, with suitable treatment, individuals with psychotic depression can expect to restore their regular functioning and return to their normal state within a few months.

When should you seek treatment?

Psychotic depression is a grave medical condition that demands immediate medical intervention. The coexistence of psychosis in individuals with depression significantly heightens the risk of suicide in comparison to those with nonpsychotic depression.

If you or someone you know is experiencing any of the symptoms mentioned, it is crucial to seek immediate assistance from a healthcare provider. Promptly reaching out to a healthcare professional is essential for proper evaluation and treatment. You may visit Mindshift Psychological Services. We offer therapy and counseling sessions for those suffering from depression or anxiety. You may contact us at (714) 584-9700 to schedule an appointment.