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: