Psychotic depression: symptoms, causes and treatments

Psychological disorders or illnesses tend to modify or alter the way in which people perceive themselves and their environment. Sometimes this distortion can become so serious that a condition such as depression ends up presenting symptoms of a psychosis.

This is what happens with psychotic depression, a rare subtype of depression that we will talk about throughout this article and that can appear in people who have already been affected by several episodes of major depression.

• Related article: "Are there several types of depression?"

What is psychotic depression?

Psychotic depression, also known as depressive psychosis, is a subtype of depression that occurs when severe depression includes some form of psychosis within its symptom picture. According to statistical data, this type of psychotic depression usually affects approximately one in four people who are admitted to a hospital with a diagnosis of depression.

Psychosis in depression can manifest itself through hallucinations of any kind, such as voices telling the person that they have no value; delusions in the form of intense feelings of worthlessness and failure or directly causing a total break with reality in the patient.

As we can see, despite the fact that they are symptoms of a psychotic illness, their content is strongly related to some of the features of depression, how can low self-esteem be.

Although psychotic depression is a diagnostic qualification on its own, it can also appear in the context of bipolar disorder or major depressive disorder. Furthermore, due to its similarities, it is very commonly mistaken for a schizoaffective disorder. However, this diagnosis requires the presence of purely psychotic symptoms for at least two weeks. That is, no depressive or mood symptoms.

Regarding unipolar psychotic depression, requires that psychotic symptoms manifest only during episodes of major depression. The diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) indicate that, for the correct diagnosis of depression psychotic, the patient must meet the requirements for a major depressive episode, along with the criteria for the specifier of "characteristics psychotic ”.

• You may be interested: "What is psychosis? Causes, symptoms and treatment"

How is it different from other psychoses?

Traditionally, it is understood that a person suffering from some type of psychosis is a person who is out of touch with reality. These patients may hear voices or present strange and illogical ideas, among many other symptoms.

When these symptoms are part of a diagnosis of psychotic depression, they usually involve behaviors such as fits of anger and anger for no apparent reason, sleeping during the day to stay awake all night, neglecting your body image and hygiene, and even, difficulties communicating with other people.

On the other hand, people who suffer from other types of mental illnesses, such as schizophrenia, also experience psychotic symptoms. However, in psychotic depression delusions or hallucinations are consistent with the arguments for depression. While the content of the psychotic symptoms of schizophrenia is usually strange and implausible and without any apparent relationship with a state of mind.

In addition, in psychotic depression patients are often ashamed of their thoughts, so they try to hide them. Hence, this type of depression is a bit difficult to diagnose. Nevertheless, an accurate diagnosis is very important, since, in addition to influencing treatment, episodes of psychotic depression are a risk factor in the development of bipolar disorder with recurrent episodes of psychotic depression, mania and even suicide.

What symptoms does it present?

People with psychotic depression experience the symptoms of a major depressive episode, including: feelings of hopelessness, worthlessness or guilt, constant fatigue, social withdrawal and agitation and irritability; accompanied by one or more psychotic symptoms, including delusions and hallucinations. Likewise, the patient may also present any of the following symptoms:

• Anhedonia serious.
• Psychomotor retardation.
• Anxiety.
• Constipation.
• Hypochondria.
• Insomnia.
• Physical immobility.

What are the causes?

Although, at the moment, it has not been determined what exact factors cause the development of psychotic depression, it has been observed that psychotic symptoms tend to develop after the person has gone through several episodes of depression without psychosis. Also, once these psychotic symptoms appear, tend to reappear in each future depressive episode.

It has also been observed that families in which some of its components have experienced psychotic depression have a higher risk of both psychotic depression and schizophrenia. This points to a possible genetic component of this disease.

A large number of patients with psychotic depression report experiencing an initial episode of depression between the ages of 20 and 40. In the same way that it occurs with other types of depression, psychotic depression is also usually episodic, with symptoms that appear over a certain period of time and diminish over time. weather. What's more, these people tend to function well both socially and professionally between depressive episodes.

Finally, although psychotic depression can be considered chronic when it lasts for more than two years, most depressive episodes last less than 24 months.

What is the treatment and prognosis?

Usually, the treatment of psychotic depression is carried out in a hospital environment, so that the patient can be monitored to guarantee the maximum safety of it.

It is usually done a pharmacological treatment accompanied by psychological therapies that facilitate the integration of the patient in her environment. In drug treatment, combinations of antidepressants and antipsychotic drugs are often used.

While antidepressants help stabilize mood, antipsychotics allow the brain to be able to perceive and organize information from the environment that surrounds the person.

An adequate treatment for psychotic depression can be really effective, to the point of allowing the patient to recover in a period of time of several months. However, due to the episodic nature of the disease, continuous medical monitoring is necessary.

In the most severe cases or those that do not respond to pharmacological treatment, the application of electroconvulsive therapy may be necessary.

Regarding the prognosis of this disease, it tends to be much more positive than other psychiatric diagnoses such as schizoaffective disorders. Still, people who experience a psychotic depressive episode are more likely to relapse and commit suicide. Hence the need for tight monitoring.