Understanding Psychotic Depression and Finding the Most Effective Treatment

Major depressive disorders can become more severe over time, and in some instances, psychotic delusions and hallucinations may be experienced by those whose depression remains untreated. Family members and friends who observe signs of psychosis in loved ones with depression should treat this as a medical emergency requiring swift, professional intervention. Fortunately, residential treatment for psychotic depression can lead to a full and lasting recovery.

When depression is left unaddressed, psychotic symptoms may eventually be experienced. In any circumstances, a psychotic break with reality is a worrisome situation that could result in severe consequences if treatment is not provided.

Understanding psychotic depression can help you prevent it from badly damaging someone you love. If you have a friend or family member who has been struggling with depression, you should be on the lookout for any signs of psychosis, which may develop suddenly and unexpectedly.

What Is Psychotic Depression?

Major depressive disorder is one of the most common of all mental health conditions. About one-fifth of American adults will experience the symptoms of major depression at some point in their lives.

This condition is difficult to manage on its own. But up to 20 percent of those who develop a serious depressive disorder will also experience psychotic symptoms as an outgrowth of their depression. This development can dramatically increase the debilitating nature of the disorder, especially if no medical services are provided.

Psychotic depression, or major depression with psychotic features, is a severe mental health disorder that requires rapid and extensive treatment. Its worst symptoms must be addressed before it can be overcome, and beyond initial intervention, treatment may need to continue for many months.

Recognizing the Signs of Psychotic Depression

Major depression with psychotic features is a complex illness that produces a complicated set of symptoms. Depression and psychosis are separate but still interrelated and mutually reinforcing, and the only way psychotic depression can be identified is if symptoms for both conditions are persistently in evidence.

Psychotic features develop after the onset of depression, making the latter the original condition. The telltale symptoms of a major depressive disorder include:

  • Chronic fatigue or low energy
  • A lack of motivation to perform even simple tasks
  • Insomnia or other abrupt changes in sleeping patterns
  • Difficulties focusing or concentrating for long periods
  • Pessimism or cynicism about everything
  • Feelings of guilt or worthlessness
  • Changes in eating habits and weight
  • Irritability, moodiness
  • Emotional flatness or numbness
  • Disinterest in previously pleasurable activities
  • Social isolation
  • Feelings of helplessness or hopelessness
  • Suicidal thoughts or behavior

People with depression know that something is not right, but they may not speak about their feelings with others. If the person with depression doesn’t get help, their symptoms will likely intensify, and it is at this point where they may be in danger of slipping into a psychotic state.

While psychotic breaks with reality can be dramatic, initial signs of psychosis may be far less distinctive or clear cut, and may not always be recognized for what they are. In other instances, psychotic symptoms may be shocking and powerful right from the beginning.

The primary symptoms of psychosis that occur in conjunction with major depression include delusions (false and irrational beliefs about the self or the world) and hallucinations (seeing, hearing, or sensing things that aren’t really there). Psychosis causes a person to lose touch with reality, and when it develops their speech and actions will reflect their distress and confusion.

These irrational ideas and perceptions will seem frighteningly and devastatingly real to someone under their influence. They will have no choice but to respond as if their delusions and hallucinations were entirely authentic because from their perspective that’s exactly what they are.

If your loved one develops psychotic depression, it is important to understand that they will be unable to ask for help on their own. It’s also vital to understand that your attempts to talk them out of their delusions will fail. When psychosis develops, you have to ask for professional assistance, and you should do it as quickly as possible to prevent anything tragic from occurring.

Understanding psychotic depression is the best defense against it, and if you can perceive what’s happening and why, you’ll know what to do when the signs become evident.

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Diagnosing Psychotic Depression

Major depression can be diagnosed if a person experiences five or more of its distinctive symptoms for a period of at least two weeks. Psychosis manifests in the form of hallucinations and delusions, and if these are reported the diagnosis can be converted to major depression with psychotic features.

Depending on the nature of the hallucinations or delusions, a person may be diagnosed with either mood-congruent or mood-incongruent psychotic depression.

Psychotic symptoms that reinforce feelings of hopelessness, worthlessness, or despair, like hearing voices that tell the person they are inferior or a failure, are consistent with the mood-congruent variety of the condition. Conversely, people with mood-incongruent psychotic depression may experience “positive” mood swings and delusions that seem inconsistent with their depression, possibly resembling the manic states associated with bipolar disorder. Their delusions or hallucinations may convince them that they’re somehow special or controlling events in the world.

As a part of the screening process, psychiatrists and psychologists will look for evidence of other conditions that might cause psychotic reactions. This will be the case even if major depression has been diagnosed first, since depression could occur simultaneously with disorders like schizophrenia or schizoaffective disorder.

If a client or their loved ones report alternating periods of depression and manic episodes, bipolar disorder might be diagnosed instead of depression. Psychotic symptoms can be experienced as an effect of severe mania, which means psychotic depression will not be diagnosed if the evidence suggests bipolar disorder is the more likely explanation.

Residential Treatment and Other Effective Interventions for Psychotic Depression

When psychosis and deep depression co-occur, it is necessary to treat both conditions simultaneously—not separately. Antidepressants combined with antipsychotic medications produce the best results in men and women who’ve been diagnosed with psychotic depression, in comparison to treatment regimens that offer one type of medication without the other.

Over time, psychiatrists have discovered some highly effective combinations of medications that can help people with psychotic depression gain control over their most troubling or debilitating symptoms. These combinations usually include antidepressants in the SSRI or SNRI classes, such as Prozac, Zoloft, or Effexor, along with proven antipsychotics like Seroquel, Zyprexa, or Risperdal.

Some experimentation may be necessary to find the ideal combination of medications, and it may take some time before the full effects of these drugs are experienced. But trained treatment professionals know how to handle these procedures safely and efficiently, and those who seek residential treatment for psychotic depression (and their family members) can rest easy knowing they are in good and caring hands.

If a person is rushed to the emergency room suffering the effects of strong delusions or hallucinations, or because their psychotic depression resulted in a suicide attempt, medications may be administered at that time. Otherwise, treatment with medication may begin in the early stages of a residential treatment program, under the close supervision of a team of mental health counselors and medical professionals. The initial phase of residential treatment at BrightQuest often includes this type of intensive 24-hour care, especially if the symptoms of mental illness are so strong that they interfere with the client’s capacity to accurately perceive reality.

At the time of admittance, our foremost concern is to make sure men and women exhibiting the symptoms of psychotic depression receive the emergency medical services they require, which will generally include round-the-clock supervision along with appropriate medications and the chance to consult with mental health experts who understand the nature of their condition. It is vitally important to treat psychotic symptoms quickly, especially if they’ve led to dangerous or reckless behavior that has put a client and/or their loved ones in danger.

BrightQuest Nashville’s Team

BrightQuest San Diego’s Team

While finding the right medication is essential to recovery from major depression with psychotic features, long-term healing requires active participation in a therapeutic regimen that is multidimensional and comprehensive, featuring a mixture of evidence-based therapies and complementary wellness practices. Under the care of world-class mental health experts who know how to design highly effective residential treatment plans, recovery from psychotic depression can be complete and sustainable, and represent an important first step toward a happier and healthier future.

If you’re concerned about a loved one and believe they may need residential care, we can help. BrightQuest offers long-term treatment for individuals struggling with complex mental illnesses. Contact us today to learn more about our program and how we can help you or your loved one start the journey toward recovery.