Depression is a term with many definitions. In everyday usage, we might use it if we feel down or blue. Clinically, the word “depression” is shorthand for many types of major depressive disorder (MDD). This is much worse than being sad. It’s a diagnosable disorder with potentially serious consequences and outcomes. A sub-form of MDD is psychotic depression. 

As the name implies, psychotic depression features a blend of MDD and psychosis. In other words, it goes beyond depression to losing touch with reality. It is possible that as many as 20 percent of adults who experience MDD also experience psychotic symptoms. 

MDD and Psychotic Depression Symptoms 

The presence of certain symptoms (hallucinations, delusions, etc.) is what enables a mental health practitioner to discern psychotic depression from MDD. These signs of psychosis might be connected with typically depressive themes or not. What matters is that they co-exist with classic MDD symptoms. Let’s get familiar with both sets of signs.

Major Depressive Disorder Symptoms 

To be diagnosed with MDD, you’d have to display several of the following symptoms for at least two weeks: 

• Feeling relentlessly sad, worthless, and guilty 

• Hopelessness and pessimism 

• Losing interest in activities that once excited you (including sex)

• Irritability and angry outbursts 

• Inability to focus, concentrate, and make decisions 

• Physical signs like sleep disturbances, unexplained aches and pains, sluggish movement, slow speech, low energy, and drastic appetite shifts

• Thoughts of death, dying, suicide, and self-harm

Psychotic Depression Symptoms

There are two big ones, of course: hallucinations and delusions. But there are more subtle red flags to watch for, e.g.: 

• Feeling numb and like you lack emotions

• Inability to keep up at work or school 

• Not taking care of yourself in terms of hygiene or how you present yourself

• Social isolation 

• Confused speech

• Behaving in a way that looks or feels paranoid or overly suspicious 

• Struggling when it comes to differentiating between reality and your inner world

Diagnosing Can Be Tricky

Despite the ominous list of collective symptoms above, it can take a while to recognize that MDD has advanced to include psychosis. This is due to the fact that people with psychotic depression can be quite aware that what they are feeling and thinking is unusual. Hence, they keep it to themselves. This is where talk therapy can be very helpful in shining a light on psychotic depression symptoms.

Treatment For Psychotic Depression

Before we get into specific clinical options, it is vital to understand that lifestyle changes can be powerful in tandem with whatever treatment plan you pursue. It’s important to commit to such a self-help regimen to manage symptoms and increase your quality of life. Some steps to consider:

• Getting sufficient sleep while maintaining a steady sleep schedule. 

• Making healthy eating and drinking choices (e.g., avoid alcohol) 

• Engage in daily exercise and physical activity.

• Stay connected to others and lean on your personal support system.

With this running parallel, here are some common approaches a professional might suggest: 

• Medication: For psychotic depression, a combination of antipsychotics and antidepressants might be prescribed. Be sure to talk about all your options, possible side effects, and dosage.

• Electroconvulsive Therapy (ECT): ECT may be suggested when a person’s response to medication and therapy is limited. This is a serious decision involving hospital admittance, anesthesia, and an electrical current. Needless to say, this is not to be considered except as a last resort.

• Talk Therapy: Approaches such as Cognitive Behavioral Therapy, Acceptance & Commitment Therapy, Experiential Psychodynamic Therapy, and Internal Family Systems have been found to be very important sources of support while a person tries medication. 

Psychotic depression must be addressed. This process can begin soon with a free and confidential consultation. 

Learn more about Treatment for Depression.