Has your boss been giving you a hard time for no reason? Have you and your significant other been going through a challenging period? Did your family pet suddenly pass away? There are events in our lives that cause us to feel depressed. Feeling depressed is a normal human reaction to adversity in our lives. It’s as normal as feeling happy when something positive happens to you, but at a certain point, that depressed feeling could indicate something more serious.
Whether it was induced by a specific event or a chemical imbalance in your brain, depression is a serious condition that can affect the quality of your life. It’s a powerful disorder that can pull you away from activities you once found joy in and turn your life into a living nightmare. If you’re depressed, you might have heard it from your friends. “Just pull it together!” “Get more sleep.” Snap out of it!” Those who aren’t aware of what depression is and the various types of depressive disorders can’t understand how it affects you as a whole. It’s not something sleep, sunshine, or drinking more water will fix.
Depression has carried a stigma for decades because of this, and despite the staggering statistics, it’s possible they’re still underreported. According to the Depression and Bipolar Support Alliance, depressive disorders affect nearly 17.3 million American adults, equating to about 7.1 percent of the entire adult population. The same statistics report that depressive disorders are more prevalent in men than women, and adults with a depressive disorder or symptoms have a 64 percent greater risk of developing coronary heart disease.
Various types of depressive disorders exist, but one in particular can be rather difficult to live with is known as depressive psychosis. According to the National Alliance on Mental Illness (NAMI), nearly 20 percent of those with major depression also have psychotic symptoms. The combination is called depressive psychosis, but it may be labeled with different names, including the following:
- Psychotic depression
- Delusional depression
- Major depressive disorder with mood-incongruent psychotic features
- Major depressive disorder with mood-congruent psychotic features
If you’ve been struggling with depression and experienced psychotic symptoms, it’s vital to schedule an appointment with your doctor to determine the causes of your depression or psychosis. If you were diagnosed with depressive psychosis and want to learn more about the symptoms, continue reading about how it can affect you and what you can do to treat it.
What Is Depressive Psychosis?
Some people who deal with severe depression will endure psychosis on top of their normal depression symptoms, including changes in appetite, depressed mood, loss of interest in activities they once enjoyed, or weight gain. Psychosis is a condition where an individual will see or hear things that aren’t there or experience false ideas about reality. There could also be disorganized or disordered thinking associated with it. When psychosis occurs in conjunction with depression, it’s considered depressive psychosis.
An estimated three to 11 percent of all people will deal with depression at some point in their lives. Of those who endure severe clinical depression, an estimated 14.7 to 18.5 percent of them will develop depression with psychotic features. Unfortunately, this depression becomes more common as a person ages.
If you’re dealing with depression and under the care of a medical professional, it’s still impossible to determine who’s prone to developing depressive psychosis. There isn’t enough research on the topic to determine its root cause. The definition and measurement tools for depression continue to evolve, which means these statistics will continue shifting. However, from what’s known today, there are specific factors that make someone prone to depression, including the following:
- Being a female: Unfortunately, as was mentioned above, women are twice as likely as men to develop depression. Women account for two-thirds of severe depression diagnoses.
- Parents or siblings with depression: Depression tends to run in families, especially severe depression. If you have a parent or sibling that struggles with depression, you’re more likely to develop it as well.
- Challenging childhood: Those who deal with adversity as children are predisposed to depression.
Symptoms of Depressive Psychosis
A person struggling with depressive psychosis will experience a variety of depressive symptoms that include the following:
- A lack of energy or fatigue
- Depressed mood
- Diminished interest or pleasure in activities they once found joy in
- Unable to concentrate
- Feeling worthless
- Feelings of guilt
- Inability to sleep
- Sleeping too much
- Suicidal thoughts
On top of these symptoms, those with depressive psychosis might also experience hallucinations, delusions, or both.
Someone with other mental illnesses like schizophrenia could also experience psychosis. In the cases of depressive psychosis, the hallucinations and delusions a person experiences are depressive and focus on one theme – hopelessness and failure.
Causes of Depressive Psychosis
While more research is needed to understand depressive psychosis, some theories behind its roots are that a specific combination of genes must be inherited for someone to develop depressive psychosis. Specific genes could be responsible for depression symptoms, while others could be responsible for psychotic symptoms. It’s possible for someone to inherit a genetic vulnerability to psychosis, depression, or both.
Other Types of Depressive Disorders
Despite how common depression might be, it’s a serious mood disorder that can have a devastating effect on people’s lives. It causes symptoms that affect how you think, feel, and handle daily activities like eating, sleeping, or working. To earn a depression diagnosis, you must have symptoms that are present for a minimum of two weeks.
All depressive disorders are not equal with different causes and how they affect someone. Below we’ll discuss the other types of depressive disorders:
- Persistent depressive disorder: Sometimes referred to as dysthymia, it’s a depressed mood that lasts for a minimum of two years. When a person is diagnosed with persistent depressive disorder, they’ll have episodes of major depression in conjunction with periods of less severe symptoms.
- Postpartum depression: Like any depression, postpartum is much more severe than having the “baby blues.” Most mild depressive symptoms or anxiety a woman faces after pregnancy will subside a few weeks after giving birth, but postpartum is a full-blown major depression that occurs during or after pregnancy. It involves extreme sadness, exhaustion, and anxiety, which leads to additional challenges to a new mother attempting to complete daily care activities for themselves or their newborn.
- Seasonal affective disorder (SAD): SAD is characterized by the onset of depression when the seasons begin to change. It’s prevalent during the winter months when there is less natural sunlight. The depression will typically subside in the spring and summer months but can cause social withdrawal, weight gain, and increased sleep that returns each year in the winter months.
Depression With Psychosis
As we’ve discussed, depression with psychosis is a subtype of major depression, which typically occurs when a severe depressive illness happens with psychosis. The psychosis can range from delusions when you experience intense feelings of worthlessness or failure, hallucinations when you hear voices telling you that you’re worthless, or some other type of break from reality. Depressive psychosis affects 25 percent of people admitted to the hospital for depression.
Major depressive disorder with psychosis differs from other variations of the condition because someone that’s psychotic loses all touch with reality. Those battling psychosis will hear voices that don’t exist or have strange twisted fantasies. One example of this is they believe others can hear their thoughts or have it out to harm them. In other cases, they genuinely believe they’re possessed by the devil, or the police are looking for them for crimes they never committed.
Depression-induced psychosis causes the individual to be angry for no reason. They’ll spend unhealthy amounts of time in bed and sleeping during the day, causing them to stay up all night. Depressive psychosis will cause them to neglect their appearance by wearing the same clothes or not bathing. The individual is often hard to communicate with because the things they say don’t make any sense.
Individuals with other mental illnesses like schizophrenia also experience psychosis. However, individuals with depressive psychosis have hallucinations or delusions consistent with themes about depression, including failure and worthlessness. With schizophrenia, psychotic symptoms are more bizarre and have no connection to a mood state, including them believing strangers are following them or trying to harass them. Individuals with depressive psychosis are often humiliated or ashamed of these thoughts and do their best to hide them. Unfortunately, this makes depression worse and more challenging to diagnose.
However, diagnosis is crucial because treatment is different from nonpsychotic depression. Having one episode of psychotic depression increases the chances of someone developing bipolar disorder with recurring episodes of mania, psychotic depression, and suicide.
Diagnosing and Treating Depressive Psychosis
In its current form, depressive psychosis is not considered an illness separate from depression. It’s regarded as a “sub-type” of major depressive disorder (MDD). To be diagnosed with depressive psychosis, a person must meet the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for major depressive disorder. The individual must also exhibit signs of psychosis, such as delusions and hallucinations.
If you’ve been diagnosed with depressive psychosis, it’s vital to seek treatment immediately. Unfortunately, there isn’t a federally approved treatment for depressive psychosis. The American Psychiatric Association (APA) suggests taking an antidepressant in conjunction with antipsychotics or electroconvulsive therapy (ECT) as a first-line treatment for depressive psychosis.
Doctors will suggest and prescribe serotonin reuptake inhibitors (SSRIs) or a serotonin-norepinephrine reuptake inhibitor (SNRI). There is some evidence showing that combination therapy with an SSRI or SNRI in conjunction with an antipsychotic is more effective than either of the two medications by themselves.
Electroconvulsive therapy is another safe and effective treatment for those with depressive psychosis who don’t find relief from medications. Since ECT offers rapid relief, it’s recommended for those dealing with suicidal thoughts. Despite being a rapid treatment, it’s an ongoing treatment and will include antidepressants to prevent it from recurring.
Psychosis can also make functioning a challenge because some people deal with distortions in their reality. Since psychosis increases the odds of self-harm, it’s vital to receive appropriate treatment. The prognosis is heavily dependent on how soon a person gets treatment and if they continue their treatment. If you’re dealing with depressive psychosis, it’s in your best interest to get help immediately.
Is Treatment Depressive Psychosis Always Successful?
Fortunately, the treatments we listed above are very effective in treating depressive psychosis. Although it might take several months, people do recover, but conditional medical follow-ups are crucial for long-term success. In rare cases, medications aren’t successful in treating depression and psychosis, which is where electroconvulsive therapy comes in. It’s vital that doctors find the most effective medicines with the least amount of side effects. Since psychotic depression is considered severe, the risk of suicide is greater than those of a milder form of depression.
Signs of Treatment-Resistant Psychotic Depression
While it might sound straightforward, treatment-resistant psychotic depression doesn’t have a simple answer. Experts cannot agree on what the terms means. Some researchers define it as depression that doesn’t respond to two antidepressants from different classes, such as SSRI or SNRI. Other experts believe an individual must experiment with four different types of treatment before depression can be regarded as “treatment-resistant.” With that said, a definition doesn’t matter – ask yourself the following questions:
- Has the treatment given by your doctor failed to improve how you feel?
- Has the treatment provided you with mild improvement, but you don’t feel like your “normal” self?
- Have the side effects of your medication been challenging to deal with?
If you’ve answered yes to any of these questions, it’s important to call your doctor right away. It doesn’t matter if you have treatment-resistant depression or not, you need extra help. Other signs include the following:
- Increased anxiety or an anxiety disorder
- Brief periods of improvement, followed by crippling depressive symptoms
- More frequent, sometimes severe or crippling and longer episodes of depression
Only a doctor can help you. Please reach out for help right away.