Depressive Psychosis or Psychotic Depression: Symptoms, Causes, Treatment, Diagnosis

Depression is a serious mental illness that can lead to many other mental and health issues, if not diagnosed on time or treated with care. Often, people neglect depression as just feeling down. Though it is normal to feel down at times, if this is a perpetual condition that persists most of the time and if one’s daily life becomes affected, then it is termed as depression and it needs immediate medical attention.

Depression can be of different kinds and patterns. They all have their very own characteristics and the causes can be different as well. In general, for ordinary people, this can be difficult to diagnose the different types of depression that one might be suffering from and consequently, they simply refer to the condition under the umbrella called depression. The types could be major depressive disorder, bipolar disorder, unipolar disorder, manic depression, depressive psychosis or alternatively known as psychotic depression. Each one has a wide range of characteristics that differentiate them from each other. Although the other types are more heard of, depressive psychosis is not much talked about; rather many a times confused with other psychotic disorders. Let us see what depressive psychosis or psychotic depression is and the symptoms, causes, diagnosis and treatment of it.

Depressive Psychosis or Psychotic Depression is a type of depression. When an individual suffering from severe depression, has psychotic symptoms, it can be called by this name. This is a sub-type of depressive disorders.

People, suffering from Depressive Psychosis or Psychotic Depression, get psychotic symptoms such as hallucinations and delusions along with all the other symptoms of depression. However, it is not schizophrenia.

People suffering from Depressive Psychosis or Psychotic Depression have symptoms of major depressive disorder as well as that of psychosis. The general symptoms of Depressive Psychosis or Psychotic Depression are –

• Hopelessness
• Guilt
• Fatigue
• Sadness
• Irritability
• Being indecisive
• Loss of interest
• Feeling worthless
• Constipation
• Change in appetite.

The psychotic symptoms included are –

• Hallucinations: Visual, auditory, touch related or haptic and smell related of olfactory hallucinations are experienced. These are related to sensations that do not exist in reality; but the patient feels and senses them.
• Delusions: False thoughts and beliefs.
• Paranoia: It is a feeling that someone is going to harm them.
• Thought Broadcasting: They feel that their thoughts can be heard by others.
• Thought Insertion: The feeling that their thoughts are not their own.
• Psychomotor Agitation: Inability to sit still and relax or physical immobility.
• Thoughts of suicide and death
• Disturbed sleep or insomnia.

These hallucinations and delusions that a person with Depressive Psychosis or Psychotic Depression experiences or gets are always negative and they reflect the extremely depressed mood of the person. The psychotic symptoms are often around self-blaming, self-punishing and self-critical.

Both Depressive Psychosis or Psychotic Depression and Schizophrenia, have certain symptoms in common or overlapping. Since Schizophrenia is a broader and more common mental disorder, Psychotic Depression is often mistaken to be Schizophrenia. However, in reality, these two are entirely different and hence, the treatment options too are quite different.

• Depressive Psychosis or Psychotic Depression: In case of Psychotic Depression, the patient experiences the psychotic symptoms only during psychotic episodes. These are mostly negative and depressing, such as voices talking about hopelessness, worthlessness, sadness and even suicide and death. The perpetual mood of the patient is depressed and unipolar or bipolar mood disorder is present, a common factor associated with this condition. Since the perpetual mood is depressed, the hallucinations and delusions are also associated with depressive themes. The psychotic symptoms in Depressive Psychosis or Psychotic Depression often occur when the mood of the person is low or she/he is feeling very down.
• Schizophrenia: On the other hand, the psychotic symptoms occurring in case of Schizophrenia have nothing to do with mood disorder. The hallucinations and delusions are always bizarre and implausible. They can be, at times, positive as well for the patient. However, the hallucinations can also be negative and threatening.

A person suffering from depressive disorders may develop signs and symptoms of Depressive Psychosis or Psychotic Depression only after he or she has had several episodes of depression, without the symptoms of psychosis. Nevertheless, the exact cause of this occurrence is not clearly known.

Research studies have proven that those, who have had this disorder in the family, may be at a higher risk of developing Depressive Psychosis or Psychotic Depression.

Hence, genes might have a role to play in this. The possible causes may be –

• Genes to Play a Major Role in the Development of Depressive Psychosis or Psychotic Depression: Interplay of some particular genes can be the cause of Depressive Psychosis or Psychotic Depression. According to a theory, there are genes that cause the psychotic symptoms and there are genes that decide the type of depressive disorder that he or she will go into. It is also found that people having a genetic history of this disorder in the family have an increased risk of having it.
• Increase in the Level of Cortisol as a Cause for Depressive Psychosis or Psychotic Depression: Cortisol is a steroid hormone that is released by the adrenal glands when encountered with stress. High level of cortisol hormone is often attributed to be a persistent cause of this condition as researches have repeatedly observed that those, who have had this condition, always had a higher level of cortisol in their blood level.
• Experience of adversity in childhood.
• Traumatic events in the recent or even in distant past can cause Depressive Psychosis or Psychotic Depression.

Depressive Psychosis or Psychotic Depression is a serious condition. It is often misdiagnosed or undiagnosed and hence, the condition worsens. However, with proper diagnosis and a proper treatment plan, Depressive Psychosis or Psychotic Depression can well be treated. The patients, in most cases, have to take medicines for about a year in order to prevent the depressive and psychotic symptoms. Within this period, patients can recover from their symptoms. However, medical follow up in frequent intervals is a must, in order to make sure that the symptoms do not recur. Usually, the depressive symptoms are more likely to recur; rather than the psychotic symptoms. Unfortunately, if the depressive symptoms recur, there is a high chance that the psychotic symptoms too will recur and hence, a long-term treatment is required.

If Depressive Psychosis or Psychotic Depression is left untreated for a long term, it can be fatal. Suicidal tendencies are very likely to occur. Not only is the person suffering from this condition is at risk, but also the safety of the people surrounding the patient may be at risk as they can be homicidal as well, though rarely.

Depressive Psychosis or Psychotic Depression must be diagnosed properly, so that proper treatment is provided. This is important as, when worsened, it can be fatal; leading a person to attempt suicide or even harm people around. However, while diagnosing this condition, it is very important that the doctor is very careful as the condition is often mistaken with schizophrenia. The problem with identifying and diagnosing Depressive Psychosis or Psychotic Depression is that the patients suffering from this condition often face trouble in sharing or expressing their experiences.

Patients suffering from Depressive Psychosis or Psychotic Depression have their psychotic symptoms or the hallucinations and delusions only in episodes, when their mood disorders are prominent. The rest of the time, they behave and act absolutely normal. Hence, they are constantly in a dilemma and conflict regarding this switch. It is because of this dilemma as well as the depressive hallucinations that lead to lack of self-confidence in these patients and they are constantly ashamed of themselves. They are afraid to express their problems. Consequently, the doctors face a lot of trouble in diagnosing the actual condition.

The doctors diagnose Depressive Psychosis or Psychotic Depression by going through the symptoms of depression. If a person has these symptoms for more than two weeks, then it is considered to be a depressive disorder. These symptoms are –

• Depressed mood
• Feeling guilty
• Suicidal thoughts
• Slow motor function or agitation
• Insomnia or too much sleep
• Lack of interest in most activities
• Changes in appetite or weight
• Low energy levels
• Difficulty concentrating.

Along with these symptoms, the person suffering from Depressive Psychosis or Psychotic Depression will also have psychotic symptoms such as hallucinations and delusions. These can be visual, auditory, touch or smell related. Psychosis means losing contact with reality and the symptoms experienced by people having psychosis or commonly known as psychotic symptoms are often experiencing things that do not exist in real.

The mental health professional checks the presence of symptoms of depression, the intensity, frequency and the period for which it is present. During the diagnosis, the presence of psychotic symptoms is also evaluated. If they are present, the onset of psychotic symptom, their frequency and intensity and the types are noted. It is also evaluated whether the psychotic symptoms were present before the onset of depression and whether psychotic are present without a depressive episode. Differential diagnosis of schizotypal and schizoaffective disorder are also evaluated as many symptoms are common.

Usually, the treatment of Depressive Psychosis or Psychotic Depression is done in a hospital setting, so that the mental health professionals have a close access to the condition and its improvement. The treatment is done in two sections, treatment for depression and treatment for psychosis. However, there is no treatment for these two conditions together.

• Medicines for Treating Depressive Psychosis or Psychotic Depression: Antidepressant and antipsychotic medicines are given to the person. The common medicines are Olanzapine, Risperidone, Quetiapine etc. These drugs work by affecting the neurotransmitters and hence, the nerve cells that connect to the brain and organise information and regulates perception, can work properly. Along with these medicines, omega-3 pills are also prescribed to reduce the general side effects of these drugs.
• Electroconvulsive Therapy (ECT) for Management of Depressive Psychosis or Psychotic Depression: This too is done under medical supervision in a hospital setting. The person suffering from Depressive Psychosis or Psychotic Depression is put to sleep by giving anaesthesia and then, controlled electric currents are sent through the brain. Thus, the function of the neurotransmitters is levelled. Though ECT has a few side effects like short term memory loss, it is quite an effective procedure that also works fast. The suicidal thoughts and psychotic episodes are reduced to a great extent through this procedure.
• Counselling and Psychotherapy for Treating Depressive Psychosis or Psychotic Depression: Counselling and therapy helps in coping with the condition, the low self-esteem and confidence. It helps in speedy recovery from the condition. Therapy can include Cognitive-behavioural approach, art therapies, Emotion-Freedom Techniques and many more. Along with these, family and couple counselling therapies are also conducted to make the family educate on the disorder and also ways in handling them. Family therapy also helps in re-building the bond with the family and acts as a great support to the client and enhances faster recovery.

Living with Depressive Psychosis or Psychotic Depression is very difficult as one is constantly bothered by low mood and psychotic symptoms along with feelings of committing suicide. Hence, it is a must for the people around to identify these symptoms well and take the person to a skilled medical professional. Proper treatment will certainly be helpful in solving these problems. However, during the treatment, one has to –

• Take the medicines properly without fail and as per the instructions of the doctor.
• Research studies have shown that exercise can have great benefit on depression. With exercise, one can achieve almost the same results as with anti-depressant medicines. However, medication must not be stopped without consulting the doctor. Exercise when done alongside taking medicine can improve the condition and provide relief much faster.
• Have a proper and healthy diet. Not only will this improve the general health, but also have a great positive impact on the mental health. In fact, when you are on so many medicines, it is very crucial that you stay healthy to cope with the side effects of the drugs.
• Staying happy and doing things that lift your mood like listening to music or similar things that one enjoys doing, can be of great help.
• Forgetfulness is a common side effect associated with the medicines of Psychotic Depression as well as the condition in itself. Not paying attention to details can be easy, but not good for the mental health. One must practice mindfulness for better mental health. Meditation can help in calming the mind and faster recovery, and increase memory and concentration power.

Depressive Psychosis or Psychotic Depression is serious condition and diagnosis and proper treatment is a must. However, because of the overlapping symptoms with schizophrenia, schizotypal and schizoaffective disorders, it can be difficult for doctors to diagnose the condition. Moreover, the person suffering from Depressive Psychosis or Psychotic Depression might not even be willing to share their experiences and episodes. Hence, compassion, attention to details and careful diagnosis are must for the doctor. This will also reduce the risk of suicide. A person diagnosed with Depressive Psychosis or Psychotic Depression responds to treatment well when proper care and support are provided.

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