Psychotic depression

Alternative names
Major depression with psychotic features; Delusional depression

Definition
This is a condition in which depression is associated with absence of contact with reality (psychosis). This can take the form of false beliefs (delusions) or detecting something that isn’t really there (hallucination). See also major depression and psychosis.

Causes, incidence, and risk factors

Although there are no obvious risk factors, a family history of depression or psychotic illness increase the risk of this condition.

Symptoms

The symptoms of psychotic depression are a combination of symptoms of depression and psychosis. This condition occurs when a depressed person loses touch with reality and hallucinates or experiences delusions.

The content of these delusions and hallucinations can be consistent with depression. For example, some people hear voices criticizing them, telling them that they are inadequate or evil, or telling them that they don’t deserve to live and should kill themselves. Psychotic depression requires immediate medical attention to prevent self-harm or harm to others.

Signs and tests

A clinical evaluation consisting of a psychiatric evaluation, a physical examination, and laboratory tests are used to make the diagnosis. Other medical conditions that can cause the same symptoms (such as reactions to certain drugs) should be ruled out.

Treatment

Treatment generally involves antidepressant and antipsychotic medication. The antipsychotics are sometimes given briefly. Electroconvulsive therapy is very effective for this condition, but it is generally a second-line treatment.

Expectations (prognosis)

The presence of psychotic features in depression reflects a more serious condition. Generally, the depressive symptoms have a higher chance of returning than the psychotic symptoms. Patients may need to take medication for a long time to prevent depression from returning.

Ongoing treatment and monitoring give the patient the best chance of recovery and doing well on an ongoing basis.

Complications

Suicide or other self-harm is the most serious complication. Patients may need to be hospitalized if they have thoughts of suicide. The safety of others must also be considered.

Calling your health care provider

Call your health care provider if you or someone you know experiences depression or psychosis.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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