person behind fog glass

Depression is one of the most common maladies in the United States. According to the National Institute of Mental Health, there were 10.3 million adults in the United States, who reported having at least one Major Depressive episode in 2016. The prevalence was highest among females, individuals between the ages of 18-25, and those identifying as bi or multi-racial.

In regards to severity, 64 % reported severe impairment.  Approximately 45% of the depressed population have experienced psychosis. Psychotic depression appeared to be more common in older adults and females.

All human beings experience sadness. As a result, the term “depression” often gets thrown around loosely. This article looks at clinical depression, commonly known as Major Depression or Major Depressive Disorder. This article further assesses psychotic features of depression.

Clinical Symptoms Of Depression

Regarding diagnostics, professionals look for specific symptoms in the assessment of depression. An individual meets diagnostic criteria for Major Depressive Disorderwhen five or more symptoms are present. A severity level accompanies the diagnosis.

• Depressed mood all day nearly every day for at least two weeks in duration
• Loss of interest in activities once enjoyed
• Significant weight loss (at least 5%)
• Sleeping too much (hypersomnia) or too little (insomnia)
• Feeling restless (psychomotor agitation) or slowed down (psychomotor retardation) most days than not
• Fatigue or loss of energy
• Feelings of worthlessness or excessive guilt
• Distraction or poor concentration
• Recurrent thoughts of death or suicidal ideations with or without a plan

Major Depression or unipolar can occur in both adults and children. It is important to note that symptoms tend to manifest themselves differently in children. For example, children often appear more angry than sad when depressed. Children are less sophisticated in understanding emotions and self-expression than adults are. Therefore, depression looks different in them.

Severity Of Depression

Major Depressive Disorder can be mild, moderate, or severe. Identifying the severity level allows clinicians to determine the level of care needed to treat individuals. Psychotic depression occurs in individuals with severe depression. However, not all individuals with severe depression exhibit psychotic symptoms. The term psychosis refers to psychotic features, such as delusional thinking or hallucinations.

Individuals with severe depression might experience auditory hallucinations or hear voices telling the individual to do bad things or that he or she is worthless. This is not the same as one’s inner voice or thoughts. Auditory hallucinations are uncontrolled voices that appear outside the mind. Also, individuals with severe depression might have visual hallucinations or see things that do not exist.

In addition to hallucinations, psychosis might involve delusional thinking, such as paranoia or false beliefs. One is considered “deluded” when he or she believes something even though there is evidence to show the beliefs are inaccurate. Delusions manifest themselves in different ways. For example, an individual might think he or she is the messiah or has magical powers, known as delusions of grandeur. Another individual suffering from delusions might experience perceived persecution, such as someone trying to poison or harm them. Like hallucinations, delusional thinking can cause significant impairment that might lead to emergency intervention. Other psychiatric disorders involve psychosis as well, such as Schizophrenia, Addiction, and Posttraumatic Stress Disorder.

Psychotic Depression Versus Schizophrenia

While psychosis is typically associated with Schizophrenia, it can appear in both Major Depression and Bipolar Disorder. Consider a middle line if you will. This line reflects normalcy. No one is right on the line, but typically slightly above or below it. Being just above or below the line is still considered within reasonable limits. It is a place where one might feel sad or somewhat elated from time to time, but it never hinders one’s functioning. When depression becomes problematic, one dips further below the line of normalcy. The same is true for mania. One moves further above the line of normality. Mania is associated with bipolar disorder and is the opposite of depression. This is why it is called bipolar disorder. The poles are opposite to one another, mania and depression. While the psychotic symptoms are the same, Schizophrenia involves chronic delusions or hallucinations and is at the center of the disorder. Whereas, psychosis is episodic when it occurs in individuals with severe mania or depression, rather than mild or moderate depression.

Treatment Modalities For Depression

People are often afraid to tell anyone when they experience psychosis because there is a considerable stereotype associated with psychosis. They fear the consequences of being ridiculed or being institutionalized. It is critical to talk to a professional when severe symptoms manifest themselves. There is an abundance of treatment options available. Professionals start with the least restrictive treatment environment in the treatment of depression. This might be monitoring a patient in therapy weekly and adding case management to assist in monitoring symptoms. When depression involves psychosis, medication is warranted to help decrease symptoms. Medication options include a combination of antidepressants and antipsychotics. Unfortunately, antipsychotics often induce serious metabolic issues and weight gain. It is not unusual for patients to experience a relapse of psychosis. Other treatment modalities include short or long-term inpatient care when needed.

Psychotic depression involves serious symptomatology that can increase suicidal ideations and lead to hospitalization. With the combination of depressive symptoms (sadness, irritability, and hopelessness) and psychosis (delusions, hallucinations, and paranoia), the condition can become lethal. Researchers continue to address the use of medication for psychotic depression and potential relapse associated with the disorder. Another possible treatment modality involves electroconvulsive therapy (ECT). This might is used in patients with severe depression that have had multiple inpatient interventions.

5 Key Points Related To Psychotic Depression

  1. Depression is the most common psychiatric disorder in the United States. Nearly 10.3 million people in the U.S. suffered from one major depressive episode in 2016.
  2. Not all people with depression are the same. Some experience mild or short-term symptoms of depression. Others experience more chronic and significant impairment from depression and need more substantial intervention.
  3.  Psychosis extends beyond schizophrenia and can impact people with depression and bipolar disorders. Certain legal and illegal drugs may also cause psychosis.
  4. Depression looks different in children as opposed to adults. Children may exhibit different kinds of outbursts that you wouldn’t see in many cases of adult depression.
  5. There is help for psychotic depression for those who seek it. Treatment generally consists of therapy and medications.