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Psychotic Depression: Causes, Symptoms & Treatment

Psychotic Depression

Psychotic Depression is primarily defined in terms of depressive symptoms that come along with psychosis. Psychosis is the condition wherein a person either has an indistinct view of reality or loses connection with reality.

Although the depression is not as common as melancholic or non-melancholic depression, it is quite severe in nature. In fact, one may evaluate the severity of psychotic depression from the fact that around one-fourth of the people suffer from the problem of psychotic depression out of all the patients admitted to the hospital for depression.

The propensity to develop psychotic depression increases in an individual who has a family history of it.

Normally during this depression, people begin to suffer from various unusual and extremely odd behavioral changes. They begin to hallucinate and develop irrational fears and thoughts. Their delusions have the potential to drive them crazy. In acute cases, they become paranoid and start hearing things and seeing things which are not present in reality.

How it begins? Complex Lifestyle and Disheartening Incidents May Trigger Psychotic Depression

Naturally, it does not happen that you wake up one fine day and discover that you are hallucinating and hence, suffering from psychotic depression. It develops very gradually and often needs a major incident in your life to trigger it.

In most cases it has been observed that patients do suffer from a certain (minimal) extent of depression since their childhood, and it later takes the giant shape due to some extraordinarily disheartening event or incident. It all begins to grow when the patient starts losing self-esteem and confidence and keep becoming more and more vulnerable.

Psychotic Depression Symptoms

A lot of people suffering from this type of major depression may find that they hear or see things which are not real. Medical professionals call these observances as hallucinations. They may also suffer from a wide variety thoughts and fears that are considered to be irrational and is referred by medical professionals as delusions.

Medical complications are also common in people who suffer from psychotic depression. They may exhibit high levels of irritability, anger and agitation. Paranoia is another factor that is quite common among those who are suffering from this kind of major depression. They will believe that other people are out to hurt them or their possessions even though this thought has no basis in reality.

A lot of individuals with psychotic depression will experience anxiety or may grow a secondary anxiety disorder like obsessive-compulsive disorder, generalized anxiety disorder or agoraphobia as well as panic attacks are quite common among them. Many psychotic depression sufferers may have sleep complications such as insomnia. The depressed individual may stay awake throughout the night and sleep most often during the day.

In addition to this, actual mobility issues and physical complications may also be experienced by psychotic depression sufferers. Cognitive impairment, mental complications and other issues are commonly related to people suffering from psychotic depression.

Since the sufferers of psychotic depression are aware of the fact that whatever they are thinking and relatively doing is somehow absurd and hold no connection to the reality or reason, they often try to conceal their activities. They would not openly talk about it and hence, diagnosing the core symptoms often gets problematic. Mentioned below are some common symptoms which they are not able to hide, even if they attempt to -
  • Disturbed state
  • Anxiety
  • Lack of sleep or insomnia
  • Constipation
  • Hypochondria
  • Lack of physical activities
  • Agitation
  • frequent mood swings
  • Irrational behaviors
  • Cognitive impairment

Psychotic Depression vs Schizophrenia

One should not confuse Psychotic Depression with other complex mental problems such as Schizophrenia which also shows very similar symptoms. But the difference here is that psychotic depression patients know and are aware of the fact that their hallucinations, delusions and irrational thoughts are not for real.

Unfortunately, even after knowing this fact, they lose the ability to pull themselves together and lose control over their thinking process.

Since they are aware of the fact that their thinking is not rational, they try to hide their thoughts and actions related to it, so that they do not get embarrassed in front of anyone.

The desperation to look normal often makes the job of identifying or diagnosing the disorder highly complicated. On the other hand, if not diagnosed at the right time, psychotic depression may also give birth to the threat of bipolar depression, inveterate episodes of the depression and suicidal tendencies.

Psychotic Depression Causes

It is almost impossible to come up with an exact cause of Psychotic Depression. Even after a number of researches, medical experts have only managed to deduce that the most likely cause of depressive disorder with psychotic features is the increased quantity of cortisol in the blood.

Cortisol is basically a vital steroid hormone generated by the adrenal glands. A definite prototype has been observed within the blood levels of this hormone during the day. Generally, its lowest level is recorded during late afternoon around 4 o’clock. A good amount of cortisol is produced when an individual feels stressed out both biologically and psychologically.

Psychotic Depression Treatment

People who suffer from psychotic depression most often gain benefit from clinical based treatments. There is a wide variety of different medications which are used to treat people that suffer from this type of depression. The medications utilized for this form of depression include anti-psychotic medications, special neuroleptic medications and antidepressants. Counseling sessions either one on one or by group and specialized therapies like cognitive behavioral therapy are also used in psychotic depression treatment.

The objective of the treatment is to stabilize the unstable moods of an individual that suffers from this condition. If the person suffers from delusions or hallucinations, medications appropriate for treating this condition will be used. It is important to provide the individual that shows psychotic depression symptoms with proper treatment to avoid instances such as committing suicide or unnecessary accidents due to their state of mind.

Patients suffering from this disorder are often asked to stay in the hospital for a considerable amount of time and required to strictly follow-up by a mental health professional on a regular basis.

Medication: Psychotic depression normally cannot be completely cured with the help of natural therapies and psychotherapy. Medications such as tricyclic antidepressants and antipsychotic are prescribed to reduce the symptoms. If by now the patient has developed bipolar disorder as well, medication containing lithium is also suggested.

Electroconvulsive therapy (ECT):  ECT is primarily the option of treatment in highly acute cases. In this therapy, electric current is given to the patient by attaching electrodes on the scalp. The therapy is usually conducted for about 30 to 90 seconds and requires around 6 to 10 sessions. The therapy results in much controlled convulsions and good amount of neurochemical production in the brain. To avoid any kind of memory losses and other major side effects, during the shock treatment, patients are always given anesthesia.

Besides these treatments, continuous efforts are being taken by the doctors to come up with more efficient and less hurtful treatments. Many medical researchers believe that the effectiveness of RU-486 which is mainly available in the form of an abortion pill and emergency contraceptive can turn out to be truly relieving for psychotic depression.

Post treatment: Things to Remember

Time has proved again and again that treating psychotic depression is possible. In many cases, regular treatment has shown good results and people have successfully recovered. Normally, it takes only a year to cure the disorder from the root. However, even after the treatment, regular sessions with your doctor are highly recommended because the re-occurrence of the depressive symptoms is possible at a very high rate. Also, the patient should be in contact with the therapist to ensure his or her well-being.

A Note of Concern for Family and Friends

If any of your family member or friend is suffering from Psychotic depression and shows various unusual symptoms then instead of trying to control them forcefully or mock them, it is recommended to understand them. Without letting them know that they are doing something very unusual, one should try to stay normal with them and slightly avert them from getting engaged in irrational thoughts.

Even during the treatment, support and care should be shown repeatedly so that the patient can regain self-confidence and generate the determination to get rid of this disorder.


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