Psychotic depression (also known as major depression with psychotic features) is a very serious form of disorder characterized by delusional thinking affected by mood swings and observable changes in cerebral tissue. It is estimated that 10 to 15 percent of people with severe depression will eventually develop symptoms of psychosis. It is considered to be underdiagnosed and undertreated, though scientific knowledge and awareness regarding this form of depression have been on the rise in recent years due to advances in research.
Psychotic depression is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM)-V as a subclassification of major depressive disorder. One key optic the disorder exhibits is a combination of depressed mood with psychosis, typically in the form of persistent and morbid hallucinations or delusions.
Psychosis: the Lowdown
What is psychosis? Psychosis can occur in the form of an episode or a condition in which an individual cannot clearly distinguish between what is real and what is imagined.
A “psychotic break” occurs when an individual experiences an episode of acute psychosis after a significant symptom-free period, though more typically for the very first time. This psychotic break may or may not be related to depression. Similarly, a psychotic disorder, or delusional disorder, can occur independently of or in relation to a depressive disorder.
Psychotic, or psychosis, symptoms typically develop after the patient has had several bouts of severe depression without psychosis. Once psychotic symptoms have manifested themselves, they tend to reappear with each future depressive episode.
Anyone who has been diagnosed with major depressive disorder should become educated in psychotic depression to better understand what they might need to be on the watch for. Here are five things to be aware of.
- Misdiagnosis of psychotic depression is often a result of clinicians’ lack of recognition of pertinent psychotic symptoms, according to the National Institute of Mental Health (NIMH). Close to one-third of observed misdiagnoses in one study most commonly misdiagnosed psychotic depression as major depressive disorder without psychotic features. Other misdiagnoses included depression not otherwise specified (NOS), or mood disorder Surprisingly, none of the misdiagnosed individuals were considered to have any psychotic disorder whatsoever. This appears to suggest that the diagnosing mental health professionals were completely missing the psychosis rather than the mood disorder.
- Major depressive disorder (including psychotic depression) and dysthymia (persistent depression) can “play off” of one another to create what is known as “double depression.” When dysthymia is present, a major depressive or depression-related psychotic episode can end, but an individual will revert to his or her normal, chronic level of persistent depression. Without proper treatment for double depression, the individual is likely going to continue relapsing into double depression.
- Psychotic depression and bipolar disorder have shown signs of being interrelated. A family history of bipolar disorder has been shown to be a risk factor for psychotic depression but not for non-psychotic depression. Research has indicated that individuals with psychotic depression (particularly those diagnosed at an early age), may have a higher risk than non-psychotic depressed individuals of later developing bipolar disorder. Those related to individuals with psychotic depression are also at higher risk of developing bipolar disorder than relatives of those with nonpsychotic depression.
- Hallucinations vs. Delusions. Hallucinations are more typically visual or auditory, though they may also be olfactory (smell) or tactile (touch). Delusions may or may not be tied in with an individual’s depressive mood (mood-congruent delusions vs. mood-incongruent delusions). Mood-congruent delusions might involve overwhelming feelings of inferiority, illness, severe guilt, or deserving of punishment. Mood-incongruent delusions might involve heightened, artificial feelings of grandeur, despite a depressive mood (you may have heard the term “delusions of grandeur”). About half of those coping with psychotic depression experience more than one kind of delusion, usually without any hallucinations.
- It is common among those with psychotic depression to also experience severe anhedonia, or the inability to take pleasure in activities that are commonly considered to be pleasurable. Social anhedonia is a pronounced lack of interest in social contact, and decreased pleasure in social situations. Physical anhedonia is an inability to feel sensory pleasures in regard to eating, touching, or sex. Psychomotor retardation (a slowing down of cognitive processes and significantly slowed physical movements) is another common symptom of psychotic depression.
Needless to say, psychotic depression can be dangerous to someone. If you suspect that you or someone you love might be having a psychotic episode, or worse, might become suicidal or exercise poor judgment that could end up being dangerous for anyone, get help as quickly as possible. If you are protecting a loved one, avoid a confrontation and secretly hide car keys, guns, alcohol, and any drugs, prescription or illegal, that could possibly result in an overdose. If a situation becomes urgent, you may need to call 911 and request a “mental health check.”
Are you or someone you know dealing with hallucinatory experiences in addition to depressive symptoms? It doesn’t have to get into crisis mode before professional help is sought. Arrange a visit to talk to someone about mental health issues that seem overwhelming. Consider reaching out to our expert team at Solara Mental Health at 844-600-9747.