Psychotic depression: symptoms and treatment

Psychotic depression is a subtype of major depression. It is often confused with schizophrenia due to the appearance of hallucinations and delusions, however, despite the severity (and danger) it responds well to treatments.

We all know what depression is more or less accurately.. A person with depression is suffering from a mental disorder that is included in the “bible” of psychologists: the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). But what about a person with psychotic depression? What is he going through?

The DSM-5 establishes diagnostic criteria so that mental health professionals can diagnose it correctly. However, Not all people with depression suffer the same symptoms.

Thus, one of the most striking is undoubtedly psychotic depression. It is that disorder where the person perceives themselves and their surroundings in a very altered, complex and even dramatic way. Sometimes, This distortion can reach an extreme where the symptoms are the same as in a psychosis. Let’s see more data below.

“I think the saddest people always do everything they can to make others happy. We do it this way because we know what it is to feel absolutely worthless.”

-Robin Williams-

What is psychotic depression?

Psychotic depression can be easily confused with schizophrenia since, Sometimes depression can manifest with psychotic symptoms, such as hallucinations or delusions.

The diagnosis process can often be complicated. However, Along with these psychotic symptoms there is a recurring factor that already reveals the presence of some type of depression: low self-esteem.We are facing a serious and dangerous condition. Likewise, it should be noted that psychotic depression is a subtype of major depression. It falls within this clinical picture with the characteristic that hallucinations and psychotic behaviors appear.

The doctor Barnett S. Meyers, from Cornell University, conducted a study where he showed that Between 20 and 40% of people with major depression end up developing psychotic depression. However, there is a hopeful fact: 95% respond positively to the treatment.

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A trigger: the episode of major depression

As we have pointed out, psychotic depression derives from a major depressive disorder. To better understand this condition, let’s look at its symptoms:

In people with major depression, there must be a depressed mood most of the day, in addition to almost every day. Often, the presenting symptoms are insomnia and fatigue. At first, the person may deny that they are sad, but the sadness may be inferred from their facial expression or behavior. Fatigue and sleep disturbance appear in a high proportion of caseswhich is quite significant when making the diagnosis.The main feature of the major depressive episode It is a period of time of at least two weeks during which there is depressed mood or loss of interest or the ability to experience pleasure in almost all activities.

The patient must experience at least four additional symptoms from a list which includes changes in appetite or weight and psychomotor activity, decreased energy, feelings of worthlessness or guilt, difficulties thinking, concentrating or making decisions, and recurrent thoughts of death or suicidal ideation, suicide plans or attempts.

Symptoms should persist for most of the day, almost daily. This must occur for at least two consecutive weeks. The episode must be accompanied by great discomfort or an alteration in the functioning of important areas of life.

Psychotic symptoms: loss of contact with reality

The symptoms that occur in major depression with psychotic symptoms (or psychotic depression) are those that we have just seen in the previous section, also adding symptoms of loss of contact with reality. These psychotic symptoms are the following:

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Hallucinations. The person who has hallucinations hears, sees or smells things that do not exist in reality. Auditory hallucinations of the type are common. “You do not deserve to live” either “You are not competent enough.”Delusions. The most well-known and cited definition is the one offered by Jaspers in his General Psychopathology (1975). For Jaspers, delusions are false judgments that are characterized because the individual maintains them with great conviction. These judgments are not influenced either by experience or by irrefutable conclusions. Furthermore, its content is impossible.

When we talk about mood-congruent psychotic symptoms We mean that, for example, the voices you hear in your head refer to how useless the person is. In the case of delusions, they would refer to, for example, suffering from an incurable disease because the person believes that “he deserves it”.

This is because one of the most characteristic symptoms of depression is feeling worthless or having a great sense of guilt. These symptoms can go so far as to manifest themselves in the form of hallucinations or delusions.

As we see, delusions usually revolve around the patient’s depressive state. For their part, hallucinations are less frequent than delusions; Furthermore, it should be noted that the case has a worse prognosis when hallucinations appear.

Characteristics of psychotic depression

The main manifestations of psychotic depression are the following:

Altered mood. The person feels great permanent sadness, which is accompanied by uncontrollable fatigue.Anhedonia. With this term we refer to the decrease or absence of pleasure in activities that previously used to provoke it. The person no longer enjoys his activities as before.Anxiety and irritability. Depression can cause symptoms of anxiety, irritability, or outbursts of anger.Slowed thinking. People with psychotic depression generally appear inhibited, with great difficulties speaking and communicating, as well as concentrating.Alterations at the motor level. The person appears slow or clumsy and has difficulty performing almost any action (eating, showering, putting on clothes…)Dry mouth, sexual dysfunctions or feeling of constant fatigue.Behavioral alterations. The person may display extravagant behaviors, such as crying excessively, yelling, or complaining about anything.Presence of delusions and/or hallucinations.

Treatment of psychotic depression

Psychotic depression is not easy to treat. In most cases it requires hospitalization of the patient due to the high risk of suicide associated with the pathology. The intervention of choice is pharmacological, followed by psychological intervention in a combined manner.

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There are several drugs that have been shown to be effective in treating psychotic depression. Usually are used antidepressants to regulate mood and antipsychotics to combat hallucinations and delusions. In fact, studies such as the one carried out at the University of Massachusetts show us that this combination is the most effective.

Psychotic depression is a serious mental disorder, since it constitutes a vital risk for the person who suffers from it. Finding a good treatment to control and reduce the intensity of symptoms is of vital importance.