July 22, 2022

What is Psychotic Depression?

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Medicially Reviewed By:
Dr. Priya Chaudhri
credentials here

Psychotic depression is a subtype of major depressive disorder (MDD) that features impaired perceptions, such as delusions or hallucinations. Read on to learn more about psychotic depression.

What is Major Depressive Disorder?

Depression is the second leading mental health disorder, with 21 million people struggling with it each year. MDD is diagnosed when at least five of these symptoms are present most of the time for two weeks:

  • Low mood, hopelessness, sadness.
  • Fatigue
  • Changes in eating habits and weight.
  • Slowed motor movements and thinking.
  • Sleep problems.
  • Loss of interest in daily life.
  • Feelings of guilt or shame that is not rational.
  • Trouble making decisions.
  • Thoughts of suicide.

What is Psychotic Depression?

Suffering from depression is very difficult, but imagine if this condition also included psychosis. For some people, they have a form of mental health disorder that can alter perceptions, called psychotic depression. Between 14%-50% of those who battle depression have this subtype of mood disorder.

This type of MDD causes the person to have visual and auditory delusions or hallucinations. In other words, they see and hear things that are not really there. These patients seem to have a much lower incidence of hallucinations as compared to delusions. Also, the delusions seem very real, so it is hard to discern if what they believe has happened really has or hasn’t.

Symptoms of psychotic depression include:

  • Psychosis
  • Motor disturbance.
  • Severe agitation.
  • Feelings of guilt.
  • Sleep disorders.
  • Anxiety
  • Hypochondria

The cause of this disorder is still unknown, but some risk factors are noted. The most common risk factor is childhood trauma. If a child has experienced sexual or physical abuse or the loss of a parent, they are at much higher risk.

Psychotic depression often presents at an older age, like over the age of 60. A patient may believe they have lost all their money or are dying of a disease, even though that is not the reality.

Those with psychotic depression are at a much higher risk for suicide or self-harm. In fact, the suicide rate among these patients is five times higher than MDD without psychosis. It is not yet understood why this is, but someone with psychotic depression will need to be closely watched.

The Importance of an Accurate Diagnosis

The DSM-5 does not have a list of diagnostic criteria for this disorder. Therefore, mental health experts must attempt to pinpoint the correct diagnosis based on medical history and other possible causes.

When being diagnosed, it is important that all other possible mental health conditions with psychotic features are eliminated. Treatment planning will be highly dependent on an accurate diagnosis. In fact, psychotic depression, bipolar disorder, and schizophrenia all have much higher suicide rates than the general public. Before a diagnosis can be made, these other two mental health disorders must be dismissed:

  • Bipolar Disorder. Bipolar disorder is a type of mental illness that features extreme shifts between manic and depressive states. In most cases, the bipolar disorder appears in the teen or early adult years. NAMI reports that it affects 2.6% of the U.S. adult population or 5.7 million people. Of those with bipolar disorder, more than 80% will have a severe form of it. Bipolar type II has more enhanced depressive events.
  • Schizophrenia. Schizophrenia is a severe mental illness. It features delusional thoughts, loss of touch with reality, hallucinations, paranoid thoughts, erratic behavior, angry outbursts, and extreme moodiness. Other symptoms include disordered speech and thoughts, neglect of personal hygiene, speaking gibberish, and odd behaviors. About 3 million people in the US have this mental illness.

Patients with the symptoms of psychotic depression will also be asked about substance use. There are certain drugs that can produce psychotic symptoms, such as meth, cocaine, LSD, and heroin. A correct diagnosis is needed in order for the person to get the most accurate drugs and treatment.

Psychiatric Treatment Options for Psychotic Depression

Treatment for this subtype of MDD involves a delicate balance of meds. It has been found that combining an antidepressant with an antipsychotic offers the best results. However, it is also a fact that taking both drugs together can become risky and is associated with higher mortality. The risks versus rewards must be weighed before choosing the meds.

It has been found that ECT therapy, which used to be called shock therapy, is both safe and effective. ECT is sometimes a solution when medications alone are not improving symptoms. It involves the use of electric currents sent to the brain, which then alters brain chemistry and reduces depression symptoms. It is performed in a hospital setting under sedation.

In addition to meds and ECT, psychotherapy and holistic methods round out the treatment of this type of depression:

CBT Therapy

This is an effective therapy for MDD, as it helps the person make needed changes to their thought patterns. The therapist helps the patient identify their disordered thoughts and guides them in shifting these thoughts to be more positive.


There are many types of holistic methods that can offer helpful tools for someone with depression. These include:

  • Mindfulness. Learning how to shift thoughts away from negative ruminations and toward an awareness of the present moment can improve your mood state. Mindfulness takes some practice in order to train the mind, and also to learn how to accept your feelings.
  • Journaling. Keeping a journal is a good way to unload the distressing thoughts that are running through your mind. Just getting them out onto paper is very helpful, and can begin the process of healing when something bothers you.
  • Yoga. Yoga is a mind/body type of exercise that involves movement and focused breathing. There are many types of yoga to try out, each with its own flavor. Yoga is known to promote a more positive and calm state of mind.

Elevation Behavioral Health Luxury Residential Mental Health Treatment

Elevation Behavioral Health offers mental health treatment in an upscale private home setting. If you struggle with psychotic depression, our serene setting provides the perfect place to bring the healing process. Please give us a call today at (888) 561-0868.

Our team of experts is here to help you.