For some people who have depression, their attacks are so powerful that it damages their perception of reality.They may hear voices that do not really exist or believe harmful things about themselves that are completely untrue. These are signs of a severe form of depression known as psychotic depression, where the usual symptoms of depression are combined with psychosis – a loss of contact with reality.
Psychosis and Depression
Psychosis – whether or not as part of depression – manifests in distinct ways:
- Hallucinations: hearing voices or seeing things in the absence of any real stimuli
- Delusions: false beliefs without sufficient evidence with which to believe in them
- Catatonia: loss of control of motor skills
- Cognitive impairment that affects logical speech
Symptoms like these will be felt in combination with the symptoms of depression. For example, while a patient with depression will have periods of feeling worthless or guilty about something, a patient with psychotic depression will experience hearing voices that reinforce those feelings (hallucinations). They may believe that they have committed a crime or wrongdoing to justify their misery, even if they are completely blameless (delusions).
Psychosis is found in other mental health conditions, such as schizophrenia and severe instances of bipolar I disorder. However, PsychCentral explains that patients with psychotic depression are fully aware of their psychoses; they realize that the voices they hear and the delusions they believe are not based in reality, but they are helpless to prevent the hallucinations and false beliefs from coming to them. For this reason, patients may be too ashamed or scared to disclose this information to a loved one or doctor, making psychotic depression difficult to diagnose.
Delusions can also take the form of paranoia; not only does the patient believe that he or she has done something wrong, but they further believe that they are being persecuted (usually by law enforcement) for whatever crime they think they have committed.
The National Alliance on Mental Health reports that symptoms of psychotic depression develop in approximately 20 percent of people who have major depression. In such cases, the risk of suicidal thoughts or behavior is quite high. The American Journal of Psychiatry notes that patients with psychotic depression have double the risk of death than patients who have depression that does not present with psychosis.
For this reason, patients with psychotic depression will need to be hospitalized for residential psychiatric evaluation, both for their own safety and the safety of those around them.
Treating Psychotic Depression
Due to the severity of psychotic depression, treatment involves the prescription of antipsychotic drugs (in combination with antidepressant medication), and close observation and follow-up by doctors. The National Institute of Mental Health reports that electroconvulsive therapy (ECT) is an effective, if occasionally controversial, method of treating psychotic depression. ECT involves electrically inducing seizures to jumpstart the brain, in an attempt to reset the central nervous system, which is regulated by a small electrical current. ECT should never be thought of as a first measure and should always be employed in conjunction with more conventional treatment methods (such as antipsychotic and antidepressant medication, and psychotherapy).
Psychotic depression can be difficult for the patient and his or her loved ones, but help and treatment are available. Black Bear Lodge knows that simply making that first phone call can be the toughest part of any journey to wellness, and that’s why we’re here to answer your questions about the symptoms of psychotic depression and how to find a new life in recovery. Call now.