There’s depression, which if you have depression, most people have. And then there’s psychotic depression, or more technically known as major depressive disorder with psychotic features. This is a far less common disorder than simple depression.

Psychotic depression is characterized by not only depressive symptoms, but also by hallucinations (seeing or hearing things that aren’t really there) or delusions (irrational thoughts and fears). Often psychotically depressed people become paranoid or come to believe that their thoughts are not their own (thought insertion) or that others can ‘hear’ their thoughts (thought broadcasting).

While people with other mental illness, like schizophrenia also experience these symptoms, those with psychotic depression are usually aware that these thoughts aren’t true. They may be ashamed or embarrassed and try to hide them, sometimes making this variation difficult to diagnose. Risk of bipolar depression, recurring episodes of psychotic depression and suicide are increased after its onset.

Researchers aren’t exactly sure what causes major depressive disorder with psychotic features (psychotic depression), but it’s frequently associated with high levels in the blood of a hormone called cortisol ( Cortisol is an important steroid hormone produced by the adrenal glands. The blood levels of this hormone typically follow a pattern throughout the day, with the lowest levels occurring around 4 in the afternoon. More cortisol is released during times of stress — biological and psychological).

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:

  • Anxiety
  • Agitation
  • Hypochondria
  • Insomnia
  • Physical immobility
  • Constipation
  • Cognitive impairment

Treatment of Psychotic Depression

Treatment for psychotic depression requires a longer hospital stay and close follow-up by a mental health professional. Combinations of tricyclic antidepressants and antipsychotic medications have been most effective in easing symptoms. The addition of lithium to this combination can be beneficial for those with bipolar disorder. Electroconvulsive therapy is very effective for this condition, but it is generally a second line treatment.

Researchers are also studying the effectiveness of RU-486 (the “abortion pill” and “emergency contraceptive”), which is said to dramatically relieve psychotic depression.

Prognosis of Psychotic Depression

Treatment is very effective for psychotic depression and people are able to recover, usually within a year, but continual medical follow-up may be necessary. Generally, the depressive symptoms have a much higher rate of recurrence than the psychotic symptoms. It is important, however, that a person experiencing these symptoms be properly diagnosed because treatment is different than for other major depressive illnesses and risk of suicide is greater.

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.”