Reviewed by Dawn Brown, LPC, NCC
Nearly a fifth of all people suffering from major depression also experiences psychotic symptoms. The combination of these mental disorders is known as depressive psychosis. It is also referred to as psychosis depression or psychotic depression. Essentially, the patient will experience typical depression alongside psychotic symptoms. What this means is that an individual may imagine sensory feedback that is not real, including hearing, seeing, smelling, and imagining or believing various scenarios.
Owing to the delusionary aspect, depressive psychosis can be dangerous. This is because patients may be driven to self-harm.
Depressive Psychosis Symptoms
With depressive psychosis, symptoms are derived out of both major depression and psychosis. Exploring the depressive aspect first, an individual is likely to have a negative overview and lack general optimism. Some of these feelings may include:
- Being sad or upset
- General lack of optimism or hope
- Struggling with guilt
Individuals suffering from clinical depression will also exhibit changes in their behavioral patterns or lifestyle. This means their eating, sleeping, and energy patterns will also be affected.
Next, it's important to understand the symptoms associated with the psychotic part of depressive psychosis. These symptoms may include:
- Delusional patterns, imagining things that are not real
- Paranoia, or imagining that self-harm will emerge out of the delusionary input
An example of this type of thinking would be imagining that perhaps aliens are trying to control your life or interfere in your plans and that you deserve to be persecuted because you don't respond to their communication (which portrays symptoms similar to hybrid schizophrenia and depression sort of disorder).
What Causes Depressive Psychosis?
The short answer is that no one has found a definitive cause of depressive psychosis. As perplexing as that may sound, even with vast amounts of modern research, scientists do not understand, nor can they predict the occurrence of depressive psychosis. Some believe that it boils down to a simple chemical imbalance in the brain, but even still, there is no saying how that chemical imbalance occurs in certain people.
Risk Factors Of Depressive Psychosis
A generally accepted risk factor comes from family, and as with numerous other disorders, depressive psychosis is also believed to have a genetic component. But, a single gene has not been isolated from blaming. What is known, however, is that if an immediate family member, including a sibling or a parent, is suffering, you have a greater likelihood of experiencing psychotic depression.
Statistics reveal that women are more likely to suffer from psychotic depression than men. Similarly, older adults are particularly vulnerable when it comes to this dual disorder. In the case of this population subgroup, about 45% of those suffering from depression will also exhibit psychotic symptoms.
Diagnosing Depressive Psychosis
A diagnosis for depressive psychosis comes when your healthcare provider diagnoses both of those disorders separately and at the same time. That is where the challenge comes from as well. Many people suffering from psychotic depression may not be so forthcoming about their psychotic thought framework.
In order to diagnose depression, a healthcare provider looks at the length of the depressive episode. An episode lasting over two weeks shall be classified as depression. Additionally, the individual needs to have been experiencing at least five of the following symptoms:
- A sad, depressed mood
- Being agitated or displaying slow motor function
- Alteration in your desire to eat
- Weight gain or weight loss
- Having trouble concentrating
- Alteration in the sleep pattern: sleeping too much or sleeping too little
- Not being interested in just about anything
- Poor energy levels
- Contemplating suicide or starting to think about death a lot
If you or a loved one are experiencing suicidal thoughts, reach out for help immediately. The National Suicide Prevention Lifeline can be reached at 1-800-273-8255 and is available 24/7.
However, in addition to these symptoms, a person suffering from depressive psychosis must also exhibit psychotic symptoms.
This essentially means delusions that boil down to thinking and believing in something that isn't true, even without just cause. For example, if you did a double-take, you perhaps had just cause for suspecting something because you could not properly or entirely see the scene playing out. Delusionary activity is when such things (that may give someone the benefit of the doubt) did not even transpire. Likewise, hallucinations are about engaging in a world that does not exist. This means the individual is seeing, hearing, touching, feeling, or smelling something that just does not exist.
Complications Associated With Depressive Psychosis
As you can imagine, the confluence of two serious disorders places the individual's overall well-being at serious risk. Therefore, psychotic depression is quite often a psychiatric emergency. The individual is at an elevated level of risk concerning suicidal behavior, not merely suicidal thoughts. If the individual has reported hearing voices telling them to hurt themselves, they may need urgent intervention. For individuals suffering from depressive psychosis, professional mental health care is critically important. It is perfectly alright to reach out to emergency services if a loved one or you have been affected with extreme thoughts of self-harm.
Treatment Of Depressive Psychosis
Unfortunately, the FDA is yet to approve a treatment that is specific for depressive psychosis. Instead, professionals treat patients for depression and psychosis separately. This, of course, implies that the entire destructive resonance that emerges from the coming together of these disorders is having to be ignored. However, this also demonstrates the complexity and difficulty associated with tackling this disorder.
When it comes to electroconvulsive therapy, a healthcare provider is basically trying to press the reset button in the individual's brain. In order to do so, the individual will be prescribed general anesthesia in a formal hospital setting to be administered this therapy. Subsequently, the individual will be subjected to waves of electrical current through their brain. But there is nothing to worry about: the magnitude of the current is small and controlled at all times. The effort is directed at inducing a seizure. This is because seizures have been known to be associated with disrupting normal brain functioning, for example, in savants or in people who may have met with an unfortunate accident.
The effort is directed at altering the levels of neurotransmitters in the brain. Unfortunately, this methodology does come with a few side effects. For instance, the individual may experience short term memory loss. A section of the scientific community believes that this methodology works quickly and has shown effective results for people who may have extreme symptoms, including suicidal thoughts.
Because intervention is so pressingly required for individuals with depressive psychosis, you may want to reconsider medications and see if they allow you to come to some sort of happy medium where you can negotiate the condition somewhat better. Doctors may refer you to qualified licensed mental health professionals who may specialize in working with individuals with depressive psychosis and working with these medications in and out.
One of the common types of medication used with depressive psychosis as Selective Serotonin Reuptake Inhibitors (SSRIs). Oftentimes, treatment plans will also combine an antipsychotic as well. Examples of these compounds include olanzapine, quetiapine, and risperidone. However, be warned that these medications usually come with side effects that can sometimes be serious. It also may take several months to be effective to the point that you are seeing results or feeling a difference.
The information found in the article is not a substitute for professional medical advice. Always seek the advice of your physician or other qualified health providers with any questions you may have.
Living With Depressive Psychosis
Indeed, depressive psychosis can be an extremely challenging condition to cope with in the long run. Individuals report feeling like they have to fight a constant battle that they continue to lose. The nature of the disorder is such that even when symptoms have been under control through a combination of management techniques, individuals may find themselves getting anxious that their symptoms will come back. Along with the treatment modalities discussed above, psychotherapy is also something that is commonly employed. Psychotherapy particularly helps with the management of symptoms and working through fear and anxiety.
Living with depressive psychosis involves not merely dealing with the symptoms but also with the side effects that medications or other treatment options can bring. Some of the symptoms to watch out for include dizziness and drowsiness, memory loss associated with the electroconvulsive therapy, poor sleeping form as well as a direct impact upon your physical health (for example, changes in weight). Despite the many difficulties, medical opinion supports engaging with these treatments and fighting with your disorder.
Psychotic depression is quite a challenge for everyone involved— the patient and just as much for a true caregiver. However, with the right attitude, you increase your odds of living as normal of a life as possible. One way or another, you have to inculcate a habit of discipline and hope. If you are unsure of whether you are depressed or whether you should talk to your doctor about how you are feeling, we encourage you to take this free test on depression to help you understand your symptoms better.