Major depression with psychotic features
Major depression with psychotic features is a condition in which a person experiences depression along with reduced contact with reality (psychosis). This can take the form of false beliefs (delusions) or seeing or hearing something that isn't really there (hallucinations).
Psychotic depression; Delusional depression
Causes, incidence, and risk factors
Although there are no obvious risk factors, a family history of depression or psychotic illness increases the chances of developing this condition.
This condition occurs when a depressed person loses touch with reality and hallucinates or has delusions. People with psychotic depression have the combined symptoms of depression and psychosis.
The content of the delusions and hallucinations can be consistent with depression. For example, some people hear voices criticizing them, telling them that they are not good enough or evil, or telling them that they don't deserve to live and should kill themselves. People may develop feelings that their body is filled with cancer, or is ‘rotting inside.' Psychotic depression requires immediate medical attention to prevent self-harm or harm to others.
Signs and tests
- Psychiatric evaluation
- Physical examination
- Laboratory tests
The health care provider should rule out other medical conditions that can cause the same symptoms (such as reactions to certain drugs).
Treatment usually involves antidepressant and antipsychotic medication. Patients sometimes take antipsychotics briefly. Electroconvulsive therapy is very effective for this condition, but it is generally used after medication.
Having psychotic symptoms with depression is a serious condition. The depressive symptoms have a higher chance of returning than the psychotic symptoms. You may need to take medication for a long time to prevent depression from returning.
Ongoing treatment and monitoring offer the best chance of recovery.
Suicide or other self-harm is the most serious complication. You may need to stay in the hospital if you have thoughts of suicide. The safety of others must also be considered.
Calling your health care provider
Call your health care provider if you or someone you know experiences depression or psychosis.
Fava M, Cassano P. Mood disorders: Major depressive disorder and dysthymic disorder. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 29.
American Psychiatric Association. Practice guidelines for the treatment of patients with major depressive disorder. 2nd ed. September 2007. Accessed January 22, 2010.
David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Fred K. Berger, MD, Addiction and Forensic Psychiatrist, Scripps Memorial Hospital, La Jolla, California.
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