Psychotic depression: symptoms, causes and treatments

In this type of mental alteration the psychotic symptoms are mixed with those of depression.

Psychological disorders or illnesses tend to modify or alter the way in which people perceive themselves and their environment. Sometimes this distortion can become so severe that a condition such as depression ends up presenting symptoms of psychosis.

This is the case with psychotic depressiona rare subtype of depression which we will discuss in this article and which can appear in people who have already been affected by several episodes of major depression.

What is psychotic depression?

The psychotic depression, known also under the name of depressive psychosis, is a subtype of depression that occurs when a severe depression includes within its symptom picture some form of psychosis.. According to statistical data, this type of psychotic depression usually affects approximately one in four people who are admitted to a hospital with a diagnosis of depression.

Psychosis in depression can manifest itself through hallucinations of any kind, such as voices telling the person that he or she is worthless; delusions in the form of intense feelings of worthlessness and failure or directly cause the patient to have a total break with reality.

As we can see, although these are symptoms of a psychotic illness, the content of these symptoms is strongly related to some of the features of depression, such as low self-esteem.

Although psychotic depression forms a diagnostic qualification by itself, it can also appear in the context of bipolar disorder or major depressive disorder. Moreover, because of its similarities, it is very commonly confused with schizoaffective disorder. However, this diagnosis requires the presence of purely psychotic symptoms for at least two weeks. That is, without depressive or mood symptoms.

As for unipolar psychotic depression, requires that psychotic symptomatology is manifested only during episodes of major depression.. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnostic criteria state that, for the correct diagnosis of psychotic depression, the patient must meet the requirements for a major depressive episode, along with the criteria for the "psychotic features" specifier.

How is it different from other psychoses?

Traditionally, a person suffering from some form of psychosis is understood to be a person who is out of touch with reality. These patients may hear voices or have bizarre and illogical ideas, among many other symptoms.among many other symptoms.

When these symptoms are part of a diagnosis of psychotic depression they usually behave in ways such as outbursts of anger and rage for no apparent reason, sleeping during the day to stay awake all night, neglecting their body image and hygiene and even, difficulties in communicating with other people.

On the other hand, people suffering from other types of mental illnesses, such as schizophrenia, also experience psychotic symptoms. However, in psychotic depression delusions or hallucinations are consistent with the arguments of depression. Whereas the content of psychotic symptoms in schizophrenia is often bizarre and implausible and without any apparent relation to a mood state.

Moreover, in psychotic depression patients often feel ashamed of their thoughts, so they try to hide them. Hence, this type of depression is somewhat difficult to diagnose. However, an accurate diagnosis is very important, However, an accurate diagnosis is very importantAs well as influencing treatment, episodes of psychotic depression are a risk factor in the development of bipolar disorder with recurrent episodes of psychotic depression, mania and even suicide.

What are the symptoms?

People with psychotic depression experience the symptoms of a major depressive episode, including: feelings of hopelessness, worthlessness or guilt, constant fatigue, social withdrawal, and agitation and irritability. and agitation and irritability; accompanied by one or more psychotic symptoms including delusions and hallucinations. In addition, the patient may also present any of the following symptoms:

• Severe anhedonia.
• Psychomotor retardation..
• Anxiety.
• Constipation.
• Hypochondria.
• Insomnia.
• physical immobility

What are the causes?

Although the exact factors that cause the development of psychotic depression have not been determined at this time, it has been observed that psychotic symptoms tend to develop after a person has gone through several episodes of depression without psychosis. Also, once these psychotic symptoms appear, they tend to reappear in each episode, they tend to reappear in each future depressive episode..

It has also been observed that families in which one of its components has experienced psychotic depression have a higher risk of both psychotic depression and schizophrenia. This points to a possible genetic component of this disease.

A large number of patients with psychotic depression report having experienced an initial episode of depression between the ages of 20 and 40. As with other types of depression, psychotic depression is also often episodic, with symptoms appearing over a set period of time and diminishing over time. In addition, these individuals tend to function well both socially and socially, these individuals tend to function well both socially and professionally between episodes of depression..

Finally, while psychotic depression may be considered chronic when it lasts for more than two years, most depressive episodes have a duration of less than 24 months.

What is the treatment and prognosis?

Treatment of psychotic depression is usually carried out in a hospital setting, so that the patient can be monitored to ensure maximum safety.

Treatment is usually pharmacological treatment is usually accompanied by psychological therapies to facilitate the patient's integration into his or her environment. In pharmacological treatment, combinations of antidepressants and antipsychotic drugs are often used.

While antidepressants favor mood stabilization, antipsychotics allow the brain to be able to perceive and organize information from the surrounding environment.

Adequate treatment for psychotic depression can be really effective, to the point of allowing the patient to recover within several months. However, due to the episodic nature of the illness, continuous medical follow-up is necessary.

In severe cases or those that do not respond to pharmacological treatment, electroconvulsive therapy may be necessary.

As for the prognosis of this disease, it tends to be much more positive than other psychiatric diagnoses such as schizoaffective disorders. Even so, people who experience a psychotic depressive episode are more likely to relapse and commit suicide.. Hence the need for close follow-up.