Those who experience clinical depression will exhibit symptoms such as hopelessness, fatigue and an extremely depressed mood. In some cases, however, depression can be linked to psychosis. It is estimated that about 20 percent of people with major depression also have symptoms of psychosis.

Psychotic depression, a rare condition, occurs when a person displays both severe depression and a break with reality. The loss of contact with reality may take the form of delusions (irrational thoughts and fears), hallucinations (seeing or hearing things that aren’t really there), or thought disorders. Often psychotically depressed people believe that their thoughts are not their own (thought insertion) or that others can ‘hear’ their thoughts (thought broadcasting). The person may develop false beliefs about their body, for example, that they have cancer. They also may become paranoid. In most cases, people with psychotic depression know their symptoms are not real, unlike, for example, someone with schizophrenia. Due to this fact, a person suffering from psychotic depression may feel embarrassed or ashamed and less inclined to be upfront with their doctors about these beliefs, making diagnosis more difficult. Risk of recurring episodes of psychotic depression, bipolar depression, and suicide are increased after its onset.

While it is not known what causes psychotic depression, it is often associated with high blood levels of cortisol, a steroid hormone produced by the adrenal glands. When a person is stressed, more cortisol is released. Additionally, those with a family history of depression or psychotic illness are more prone to psychotic depression.

There are no obvious risk factors, though it is known that those with a family history of depression or psychotic illness will be more susceptible.

Symptoms of Psychotic Depression

Symptoms that occur more commonly in psychotically depressed patients include:

Constipation Agitation Physical immobility Cognitive Impairment Anxiety Insomnia Hypochondria Intellectual impairment Hallucinations/Delusions

Treatment of Psychotic Depression

Usually treatment for psychotic depression is administered in a hospital environment, with close monitoring and follow-up by a mental health professional. Different medications are used to stabilize mood, often including combinations of antidepressants and antipsychotic medications.These medications impact neurotransmitters in the brain that are often out of balance in people with psychotic depression. In many cases, a selective serotonin reuptake inhibitor (SSRI), such as fluoxetine (Prozac), is used along with one of the following antipsychotics: olanzapine (Zyprexa); quetiapine (Seroquel); and risperidone (Risperdal).

Some people with psychotic depression may not respond to medications as well as others. In these cases, the next step in treatment may be electroconvulsive therapy (ECT) to help relieve symptoms.

Psychotic depression treatment is very effective. People are able to recover, typically within a year. However, it may be helpful to seek medical follow-up to ensure recovery stays on track. In most cases it is more likely that the depressive symptoms will recur rather than the psychotic symptoms. A person experiencing these symptoms must be accurately diagnosed so that proper treatment may be administered. Treatment options are different for other major depressive illnesses and, therefore, with incorrect diagnosis, the risk of suicide may be increased.

What Psychotic Depression Is Like

Susan probably suffered from a form of depression since she was about 7 years old. Then one day, things changed dramatically for the worse.

“My marriage fell apart when I was 24. For two years after that I was ‘crazy’. Angry all the time. Tired, but I couldn’t afford to be. I had a 5 year old son to support and the rent to pay and the housework to do etc etc. I was prone to bursting into tears. I was suffering from pain in my back – my period pain was excruciating. I went to doctors, of course. I was told I probably had soft tissue damage to my back from child birth. My period pain was supposedly fixed with “the pill”. My tiredness was treated with comments like, ‘it’s probably stress, you need to relax more, here listen to this tape, or do yoga, or have you tried hypnotherapy’.”

“Then one day at work, one of my bosses made a passing comment about my “delinquent son”. He meant nothing by it, just a tease. But I started to cry. I couldn’t stop. Not even having a cup of coffee or a cigarette in my mouth could stop the tears from falling. I was still crying at 2.00pm at the end of lunch hour, so I went home. I sat in the middle of my living room floor and continued to cry.”

“As the days passed, I started to believe that the people at work were after me and were going to take my son away. When I watched the newscasts on tv, the reporters were whispering special messages warning me of impending doom and telling me what to do.”

“My mother was very worried about me and finally she said ‘you’ve gone over the edge girl – you need help’ and off to the hospital I went.”