What Causes Psychotic Depression, and How Is It Treated?

We can explore the causes and risk factors for psychotic depression and then turn our attention to the solutions. The treatment options for major depressive disorder with psychotic features are comprehensive and successful, especially when established in a long-term in-patient treatment setting.

When Linsday was 45 she went to see her doctor for an annual physical exam. They talked about some strategies for how she could deal with her low energy and general inactivity that stemmed from depression, but otherwise, she was in good health. But almost as soon as she got home from the appointment, it occurred to Lindsay that the doctor was keeping something from her and that it must be really serious. From that moment, Lindsay believed without a doubt that she had cancer. She resented the doctor for withholding information, but at the same time, she could understand because she also believed that she deserved the tragic diagnosis.

Out of touch with the reality of her good health and intrinsic self-worth, Lindsay was suffering through delusions, or psychosis, as a result of her major depressive disorder. Her distorted beliefs about her own physical health, as well as about the actions and intentions of her doctor, were wrapped up in the depressive, self-deprecating thoughts that had been familiar to her for decades. When a person experiences significant periods of depression as well as psychotic hallucinations, delusions, or paranoia, they have psychotic depression—also called depressive psychosis, delusional depression, or major depressive disorder with psychotic features. The nature of their hallucinations and delusions aren’t necessarily consistent with depressive themes, but oftentimes, their distorted sense of reality will be connected to their guilt, hopelessness, and heavy sadness.

Because of unsettling experiences not grounded in reality on top of the devastating experience of depression, sufferers of psychotic depression may be at great risk of self-neglect or of harming themselves or others. Regardless of what causes psychotic depression, the onset of psychotic symptoms presents a psychiatric emergency, and these individuals need urgent medical and psychological care. They may also be more likely to hide their symptoms of psychosis because of their depressive feelings of worthlessness and difficulty expressing themselves. So, it’s that much more important that family and friends are observant of their loved one’s experiences of depression and that they encourage a comprehensive treatment path.

What Are the Causes and Risk Factors for Psychotic Depression?

Researchers are still working to better understand mood disorders such as depression and their causes—as well as psychotic symptoms and their causes. But mood disorders can be linked directly to chemical imbalances in the brain and, generally, to biological, genetic, psychological, and environmental factors.

While so much is still unknown about the direct causes of psychotic depression, we can consider the risk factors that have been linked to incidences of the disorder:

  • Genetics. A close relative also has the disorder, a similar mood disorder, or symptoms of psychosis.
  • Gender. History shows that females develop psychotic depression at a greater rate than males do.
  • Age. Older adults tend to be more susceptible to developing psychotic depression.
  • Health problems. Illness or injury may contribute to the development of depressive disorder with psychotic features.
  • Stress and trauma. High levels of the stress hormone cortisol have been linked to psychotic depression. Stress can present itself in many forms, and it can be particularly powerful when connected with past trauma.
  • Isolation. It is also possible that isolation puts an individual at risk for developing a mood disorder.

Each case of psychotic depression, its causes, and its story are unique to the individual. So, it’s important to turn our attention to those in need of care and treatment. Fortunately, much is known about the prognosis for psychotic depression and the success of the treatment options.

Call For a Confidential Phone Assessment.


What Are the Treatment Options for Major Depression with Psychotic Features?

If someone with psychotic depression starts treatment early and stays on the treatment path in close cooperation with their medical and psychological teams, they have a good long-term chance of leading a positive life in recovery. Major depression, in general, and major depression with psychotic features, in particular, are mental health disorders that require early and persistent expert care. People with these disorders may be at great risk of suicide or other self-harm. But with adequate treatment, depressive and psychotic symptoms can be minimized, and clients can develop more aware and constructive relationships with their challenges.


While there isn’t a medication that is indicated for psychotic depression specifically, a combination of antidepressants and antipsychotics has shown to be effective with clients. But medication management must be handled very carefully to find the precise prescriptions and dosage balance for the individual. Medication is a primary approach to psychotic depression care, but for treatment-resistant clients, electroconvulsive therapy (ECT) may be a secondary treatment option.


Individual therapy can help a client to become more aware of how their depressive and psychotic symptoms are affecting them, and in this way, they don’t feel so overcome and controlled by the symptoms. Along with medication, individual psychotherapy—and eventually supportive group and family therapy—can support clients as they approach long-term recovery from psychotic depression and their responsibilities to stay on track with their treatment path.

Because of the risks of suicide and other serious types of harm, as well as the risks of substance abuse, clients with psychotic depression benefit most from long-term inpatient treatment, where professionals can thoroughly diagnose and assess their personal treatment needs. In this setting, clinicians can closely monitor any side effects of medications and work to perfect the balance of antidepressants and antipsychotics. Typically, these medications take time to become effective, and in a residential treatment environment, clients receive holistic support for coping with symptoms and developing a long-term support system for their life in recovery following in-patient treatment. Time spent in a psychotic depression treatment center empowers clients to look for solutions for their distress and to look forward to the life they really want to manifest.

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