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Lifetime Drug Treatment for Psychotic Depression

Psychotic depression is officially diagnosed as major depressive disorder, severe with psychotic features. Symptoms of this condition includes both mood disturbance and psychosis, including severe paranoia, delusions and auditory or visual hallucinations. A psychiatrist will assess the patient's history, symptom profile and treatment options for psychotic depression. This type of major depression can put the patient at risk due to the high levels of anxiety, fear and confusion that can be associated with psychotic symptoms. It is common that a patient may need hospitalization to stabilize the psychotic symptoms associated with this disorder.

  1. Signs of Psychotic Depression

    • Identifying psychotic depression includes self-reported symptoms of depression in addition to psychotic symptoms. People experiencing depression and complaining of severe paranoia, hearing voices or seeing things may be suffering from psychotic depression.

    Diagnosis

    • Diagnosing psychotic depression requires meeting with a skilled mental health professional who is able to identify symptoms of major depressive disorder along with psychotic features. Symptoms of major depressive disorder include chronic sadness, loss of pleasure, low energy, feelings of guilt, and problems with sleep or appetite and may include suicidal thoughts, plans or gestures. Psychotic features include auditory or visual hallucinations.

    Antidepressants

    • Taking an antidepressant can address the mood symptoms of psychotic depression. Some types of antidepressants include selective serotonin reuptake inhibitors (SSRI's), tricyclic antidepressants or monoamine oxidase inhibitors (MAO-I's). SSRI's are the newest type of antidepressant, are preferred by physicians and include drugs such as Prozac and Zoloft. Tricyclics and MAO-I's are older antidepressants and can create uncomfortable side effects and may not interact well with other medications. Antidepressant medication is taken on a daily basis and is recommended long term due to the relapse of symptoms if the medication is discontinued.

    Antipsychotics

    • Taking an antipsychotic can address the psychotic symptoms of this type of depression. These medications are classified as traditional or atypical agents. Traditional antipsychotics include medications such as Thorazine, Haldol or Mellaril. Atypical antipsychotics include newer forms of antipsychotic medication such as Abilify, Risperdal or Geodon. The traditional group of antipsychotics have uncomfortable and permanent side effects; therefore, the newer atypical forms are preferred by physicians and patients. Antipsychotic medication can be used in combination with antidepressants to control the psychotic features that are characteristic of this type of depression.

    Other Options

    • Treating major depressive disorder with psychotic features may also include other medications such as mood stabilizers, anticonvulsants or anxiolytic medication. If psychotic depression remains chronic and does not respond to medications, electroconvulsive therapy (ECT) may be an option. ECT is usually the last resort as it can be expensive, requires relatively good health and an inpatient stay to complete a series of treatments. ECT induces seizure activity in patients with chronic psychotic depression and can be very beneficial in resolving symptoms when all other treatment options have failed.

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