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Page medically reviewed by Dr William Shanahan, Medical Director (Private) and Clinical Director of Addictions (BAO, BCh, DCH, D'OBS, FRCPsych, MB), Priory Hospital Roehampton, in December 2021.

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Definition  |  Symptoms  |  Causes  |  Treatment  |  How to Help

What is Psychotic Depression?

Psychotic depression, which is sometimes known as ‘severe depression with psychotic symptoms’ is a type of depression that causes people to experience symptoms of psychosis, including delusions and hallucinations, as well as many of the other common symptoms of depression.

Psychotic depression can be a very frightening condition to live with. The hallucinations and delusions that people experience can be very upsetting and can lead to them feeling suicidal or having frequent thoughts about dying. If you, or someone you know, is experiencing or acting upon suicidal thoughts, it’s important that you get urgent help by:

  • Dialling 999
  • Attending your nearest A&E department

You can also access our crisis support page for more information on seeking immediate support.

Here, we will explore the symptoms of psychotic depression, what causes psychotic depression, and the treatment that’s available. We’ll also provide some tips on how you can support someone who is struggling with psychotic depression.

Psychotic Depression Symptoms

psychotic depression symptoms and causes

Essentially, someone who is psychotic is defined as being out of touch with reality. With psychotic depression, this break with reality is also accompanied by the main signs of depression.

Symptoms that are most commonly associated with psychotic depression include:

  • Hallucinations (seeing or hearing things that aren’t real)
  • Delusions (believing things that aren’t true)
  • Disordered and disorganised thinking
  • Paranoia

Alongside these, sufferers of psychotic depression may also experience many of the core symptoms of depression such as:

  • Feelings of sadness and hopelessness
  • Anxiety
  • Agitation
  • Getting angry over small matters
  • Insomnia and other sleep disturbances
  • Changes in appetite, resulting in weight changes
  • Feeling guilty
  • Difficulty concentrating
  • Neglecting your appearance and personal hygiene
  • Losing interest in activities you used to enjoy
  • Low energy

The hallucinations and delusions that people experience as part of psychotic depression often centre around some of the key themes and emotions of depression. These can include feelings of intense worthlessness, hopelessness, guilt, and feeling like a failure. For example, hallucinations may involve the person hearing a voice telling them that they’re a failure or that no-one cares about them. Delusions may involve the person holding strong beliefs that they’re worthless and failing at life, despite evidence to the contrary.

The hallucinations and delusions that people experience in psychotic depression can lead them to feel as though they’re a burden, and that their family and loved ones will be better off without them. This thinking can be powerful and very dangerous and, as outlined earlier, can lead to some people having suicidal thoughts or intentions.

In addition, some new mothers experience psychotic depression and begin to have hallucinations and delusions that often centre on their new baby. These can involve things like believing their baby will be harmed. In a similar way to postnatal depression, postnatal psychotic depression is completely treatable and we can support with this.

What Causes Psychotic Depression?

Psychotic depression is a complex illness. As is the case with depression, it’s likely that there are a number of factors that contribute to the chances of someone developing it, instead of it being down to a single cause.

Some common factors of depression may include:

  • Genetics having a close family member who struggles with psychotic depression can make you more vulnerable to suffering with it
  • Gender women are more likely than men to struggle with psychotic depression. The reasons for this are complex, but one of the contributing factors is thought to be the hormonal changes that women go through in their life, which may make them more susceptible to depressive episodes
  • Mental health if you already suffer with a mental health condition, or have done in the past, this can increase your chances of developing psychotic depression
  • Stressful life events going through something stressful or traumatic, such as a bereavement, divorce, or losing your job, can sometimes be a trigger for psychotic depression
  • Abuse – experiencing abuse and/or neglect, especially if this happened when you were a child, can increase your susceptibility to developing mental health problems in later life. This can include psychotic depression
  • Personality – certain personality traits, such as being a perfectionist or having low self-esteem, can make it more likely that you’ll develop psychotic depression

Psychotic Depression Treatment

Psychotic depression can be difficult to cope with, but effective treatments are available. Here at Priory, we can help you to overcome your symptoms with effective depression treatment and get your life back on track.

Depending on how severe your symptoms are, we can offer a number of different treatment programmes. These include:

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Therapy for psychotic depression

There are a number of therapy types that we can use to treat psychotic depression.

One of the most widely used techniques is cognitive behavioural therapy (CBT), which has been found to be effective in treating psychotic depression. CBT aims to challenge any negative and destructive beliefs that you hold about yourself (such as the ones you may experience as part of your delusions), and help you to learn ways to deal with difficulties in a more positive way.

CBT sessions also aim to give you skills for life, so you can keep on top of how you’re feeling and reduce the chances of you developing psychotic depression again in the future.

Therapy formats for psychotic depression

Each of the types of therapy that can effectively treat psychotic depression can be delivered in one of the following formats:

  • 1:1 therapy
  • Group therapy
  • Family therapy

Medication for psychotic depression

We can also offer medication to help you with psychotic depression. This is usually a combination of antidepressants (to treat your depressive symptoms) and antipsychotics (to treat your psychotic symptoms). We can also offer mood stabilisers and lithium.

Medication can be used alongside other forms of therapy and can help to manage the chemicals in your brain that are linked to your mood.

How to Help Someone with Psychotic Depression

If you’re the family member or friend of someone who has psychotic depression, it can be difficult to watch your loved one struggle. You may not know what to do for the best, or where to turn. However, there are a number of things you can do to help someone with depression:

Talk to them

Talk to the person about what they’re going through and encourage them to open up to you if they feel comfortable. By talking openly about their condition, you’ll be able to recognise when they’re going through a particularly tough time and understand their triggers, so you can support them. You can also ask them if there’s anything they want you to do to help them – this might be practical support or just simply being there to listen to them.

Help them to get help

It’s important that your loved one gets help for their psychotic depression, or this can get worse over time. You could encourage them to make an appointment with their GP and offer to go along with them as moral support. Their GP will be able to review their symptoms and refer them for specialist help if needed. Or you could call Priory directly to talk through your loved one’s condition, and our friendly team will be able to advise on next steps.

Look after yourself

Looking after someone with psychotic depression can be draining. That’s why it’s really important that you look after yourself too during this time. Make sure you do something each day that you find relaxing or enjoyable. Remember – you can’t pour from an empty cup.

At Priory, our experts can provide specialist treatment for psychotic depression, helping you to overcome your symptoms and start to feel like your old self again.

Get the Best Mental Health Support

For details of how Priory can provide you with assistance regarding mental health and wellbeing, please call 0800 840 3219 or make an enquiry. For professionals looking to make a referral, please click here.

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