Psychotic Depression Diagnosis

Psychotic depression, also called major depression with psychotic features, occurs when depression and psychosis are combined. Someone may feel the depth of depression while being in psychotic episodes. Although psychosis can be recurrent, it is easier to treat than depression, which may require lifelong maintenance.

Definition of Depression

• Major depression is a display of five or more of the following symptoms lasting over two weeks: pessimism, sadness, hopelessness, feelings of worthless, agitation, appetite changes, lack of energy, inability to concentrate, withdrawal from enjoyable activities, thoughts of suicide, and insomnia or too much sleep. Depression affects thinking and when it coincides with psychosis it may make thinking patterns more abstract and disconnected. Coupled with psychosis, depression can be disabling and very dangerous.

Definition of Psychosis

• Psychosis is a loss of contact with reality. This term encompasses visual, audible and olfactory hallucinations, as well as a harder to pin down change of perception wherein a patient views the world differently than people without psychosis. Someone with psychosis may feel pressured or compelled to act in erratic or irrational ways or may become extremely paranoid. Psychosis also includes delusions, which are false ideas or feelings that are not plausible in reality. Common manifestations are persecutory delusions, which occur when someone believes they are being unjustly persecuted, and delusions of reference, which occur when people mistakenly believe dates, songs, books, spoken comments or actions have significant meaning to the psychotic person alone.

Diagnosis

• Diagnosing this condition can be difficult. The wide array of psychotic features that may be present makes it difficult to narrow down those specifically related to major depression. However, there are some similarities in symptoms among persons with psychotic depression, such as abnormal displays of emotion, confusion, thoughts of suicide, disorganized speech and thought (speech and thought that either travels too rapidly or too slowly), mania, delusions, loss of touch with reality and skewered perceptions, hallucinations and constant fear.

  Note that psychotic features may mask the underlying type of depression because they are present in many other psychiatric disorders such as bipolar disorder and schizophrenia. Therefore, it is essential to provide your doctor with a full list of your symptoms, even if you're embarrassed by the more irrational ones or are afraid that admitting to thoughts of suicide will land you in a mental health facility.

Treatment

• Treatment is usually combined use of antipsychotics and antidepressants. In cases of major depression with psychotic features when someone experiences manias, the addition of antidepressants may be detrimental. They may cause the patient to go into a serious mania if they are not combined with an effective antipsychotic. Likewise, an antipsychotic without an antidepressant will not properly treat the depression. Antipsychotics help to reduce the psychotic features such as hearing voices and hallucinations.

Warning

• Be cautious when taking both antidepressants and antipsychotics. Antipsychotics can cause a condition known as Tardive Dyskenisia, which is displayed by painful, repetitive, and purposeless contractions of muscles. It may be permanent in some cases. Antidepressants may also increase thoughts of suicide in teens and young adults. Both medications should be handled with care. Immediately consult you doctor if you experience thoughts of suicide or any adverse effects such as painful twitching or rashes from allergic reactions.