Psychotic depression can feel frightening, confusing and deeply isolating. When severe depressive symptoms combine with hallucinations, delusions or a loss of connection with reality, everyday life can become overwhelming.
However, psychotic depression is treatable. With the right support, many people experience significant improvement in their symptoms and regain stability and clarity.
If you think you or someone close to you may be experiencing psychotic depression, understanding what is happening can be an important first step towards accessing specialist care.
If you or someone else is at immediate risk, call 999 or attend your nearest A&E department. You can also visit Priory’s crisis support page for urgent guidance.
Psychotic depression, sometimes referred to as severe depression with psychotic features, is a form of major depressive disorder that involves both:
Psychosis affects how someone interprets reality. In psychotic depression, these experiences often reflect themes of hopelessness, guilt, worthlessness or self-criticism that are already present in the depressive episode.
Because of this, psychotic depression can be particularly distressing and may significantly affect safety, functioning and emotional wellbeing. Early assessment and treatment are important.
Psychotic depression combines symptoms of severe depression with symptoms of psychosis. Experiences vary from person to person.
These may include:
Psychotic experiences often reflect the tone of the depression. For example, someone may hear a voice criticising them or believe they have caused harm despite reassurance to the contrary.
In addition to psychosis, symptoms of severe depression may include:
Psychotic depression may also involve thoughts of self-harm or suicide. This requires urgent medical attention.
In some cases, new mothers may experience hallucinations or delusions related to their baby. This may form part of postnatal depression and requires urgent assessment. With prompt treatment, outcomes can be very positive.
There is no single cause of psychotic depression. It usually develops due to a combination of biological, psychological and environmental factors.
These may include:
Genetics - A family history of severe depression or psychotic illness may increase vulnerability.
Hormonal changes -Hormonal shifts during pregnancy, after childbirth or during menopause may contribute.
Existing mental health difficulties - A history of depression, anxiety or other psychiatric conditions can increase risk.
Stressful life events - Bereavement, relationship difficulties, trauma or major life changes can trigger or worsen symptoms.
Childhood adversity - Early experiences of trauma, neglect or abuse may affect emotional regulation later in life.
Personality traits - People who are highly self-critical or prone to low self-esteem may be more vulnerable during periods of stress.
Diagnosis involves a thorough mental health assessment carried out by a GP, psychiatrist or psychologist.
This typically includes:
Because psychotic depression is a serious mental health condition, early diagnosis allows timely access to appropriate treatment.
Psychotic depression is treatable. Treatment is usually tailored to the severity of symptoms and the individual’s needs.
Many people benefit from a short period of inpatient care, particularly if symptoms are severe or safety is a concern. Inpatient treatment provides:
This setting can help stabilise symptoms in a safe and supportive way.
If symptoms are stable enough to be managed at home, outpatient or day care treatment offers regular therapy and psychiatric input while allowing someone to maintain aspects of their usual routine.
Online therapy can offer flexible access to psychological support, particularly during step-down care or where remote sessions are preferred.
Psychological therapy plays a central role in treatment.
CBT is commonly used and can help you:
Depending on individual needs, treatment may also include:
Therapy may be delivered individually, in groups or with family involvement.
Medication is often an important part of treatment. This may include:
A consultant psychiatrist will carefully assess and monitor depression medication to support symptom stabilisation and longer-term management.
Supporting a loved one can feel overwhelming. You may find it helpful to:
Encourage open communication - Listen calmly and without judgement, allowing them to share at their own pace
Help them access professional support - Offer practical support such as attending appointments or contacting their GP or a private provider.
Learn about the condition - Understanding psychotic depression can help you respond with reassurance rather than fear.
Look after your own wellbeing - Supporting someone with severe mental illness can be emotionally demanding. Ensure you also access support when needed.
Psychotic depression can feel all-consuming, but specialist treatment can make a significant difference.
At Priory, our experienced teams offer inpatient, outpatient and online treatment options tailored to individual needs. You can begin with a confidential mental health assessment to explore what you are experiencing and discuss the most appropriate treatment pathway.
You do not have to face this alone.
