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Depression Health Center

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Psychotic Depression

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Psychotic depression is a subtype of major depression that occurs when a severe depressive illness includes some form of psychosis. The psychosis could be hallucinations (such as hearing a voice telling you that you are no good or worthless), delusions (such as, intense feelings of worthlessness, failure, or having committed a sin) or some other break with reality. Psychotic depression affects roughly one out of every four people admitted to the hospital for depression.

How Is Psychotic Depression Different From Major or Clinical Nonpsychotic Depression?

According to the National Institute of Mental Health, a person who is psychotic is out of touch with reality. People with psychosis may hear "voices." Or they may have strange and illogical ideas. For example, they may think that others can hear their thoughts or are trying to harm them. Or they might think they are possessed by the devil or are wanted by the police for having committed a crime that they really did not commit.

People with psychotic depression may get angry for no apparent reason. Or they may spend a lot of time by themselves or in bed, sleeping during the day and staying awake at night. A person with psychotic depression may neglect appearance by not bathing or changing clothes. Or that person may be hard to talk to. Perhaps he or she barely talks or else says things that make no sense.

People with other mental illnesses, such as schizophrenia, also experience psychosis. But those with psychotic depression usually have delusions or hallucinations that are consistent with themes about depression (such as worthlessness or failure), whereas psychotic symptoms in schizophrenia are more often bizarre or implausible and have no obvious connection to a mood state (for example, thinking strangers are following them for no reason other than to harass them). People with psychotic depression also may be humiliated or ashamed of the thoughts and try to hide them. Doing so makes this type of depression very difficult to diagnose.

But diagnosis is important. Its treatment is different than for nonpsychotic depression. Also, having one episode of psychotic depression increases the chance of bipolar disorder with recurring episodes of psychotic depression, mania, and even suicide.

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