What is Psychotic Depression? Symptoms, Causes, Treatment 

Psychotic depression is a subcategory of MDD (major depressive disorder), and its signs are sleeping problems, listlessness, and sad feelings. Today, we’ll discuss what is psychotic depression, its symptoms, causes, and treatment.

What is Psychotic Depression? 

Psychotic depression outlines the signs of psychosis in the episode of depression. The psychosis consists of a state of stupor, psychomotor impairment, delusion, and hallucination.

According to an estimate, MDD with psychosis impacts approximately 10-19% of the people that are experiencing the phase of major depression. Many experts think that MDD with psychosis could happen at a higher rate because clinics don’t identify psychosis while diagnosing depression. A study conducted in 2008 based on the clinical data of various medical centers showed that clinicians misdiagnosed this condition approximately 27% of the time.

Major Depression vs. Psychotic Depression

Clinical depression or MDD could impact your physical health, mood, and behavior in your everyday life. The episode of MDD would comprise of exhibiting more than four signs of depression and having a low mood and losing interest persistently for two weeks.

On the other hand, psychosis doesn’t outline the nine main signs of depression, and most people with MDD condition never face psychosis.

The 5th edition of DSM-5 (diagnostic statistical manual of mental disorder) separately categorizes them and listed depression with the features of psychosis as a “specific depressive disorder.” As we’re aware of the fact that depression is a serious mental illness. However, many psychologists say that MDD with psychosis is more dangerous and severe than depression without signs of psychosis because it comprises of following;

  • Suicidal thoughts or the risk of harming yourself
  • Exhibiting severe symptoms
  • Features of melancholy

Symptoms of Psychotic Depression 

Symptoms of MDD

Some of the main symptoms of major depression disorder (MDD) are as follows;

  • Suicidal and death/dying thoughts frequently
  • Feelings of guilt, self-hatred, helplessness, and worthlessness
  • Difficulty in decision making and focusing
  • Sense of slowing down, high restlessness, and changes in your movement
  • Sudden change in your weight and appetite without any explanation
  • Losing interest in the pleasurable activities that you used to enjoy
  • Feelings of hopelessness, sadness, emptiness, and low mood; some people would say that life isn’t worth living and others would feel more irritable than sad

Symptoms Psychosis Depression

Psychosis comprises of a person’s disconnection and breaking up from reality. People aren’t aware of the symptoms while experiencing them, and it comprises of following symptoms;

  • A stupor state where you can’t respond, speak or move in your environment
  • Feelings of movements, slowed thoughts, and psychomotor impairment
  • Believing in things that aren’t true, and delusional
  • Feelings, hearing, and seeing things that aren’t real or hallucinating

Delusions and psychosis hallucination would comprise of following;

  • Extreme suspicion, irrational, and paranoia about other people
  • Feeling threatened or frightened to see animals following you
  • Hearing things that mock or criticize you
  • Thinking that you’re a famous or a historical figure
  • Believing that you’re special and have unique powers
  • Thinking that you’ve got serious health problems, even though tests suggest a completely different thing

People with psychosis would experience hallucinations. People experience delusion with/with hallucination often. However, many psychologists have separated MDD with psychosis into two main categories;

MDD with Mood-congruent psychotic Features:

Delusions and hallucination would reflect in the form of emotions and feelings that often exhibit in depression; along with feelings of worthlessness, fear of death or illness, and guilty and inadequate feelings

MDD with Mood-incongruent psychotic Features:

Delusions and hallucinations create a conflict with your depressive emotions. You would hallucinate of smelling something pleasant, hearing appreciating voices, or seeing a loved one. Here you believe that someone is controlling your thoughts, kidnapping, or tracking you.

The episode of delusions and hallucination would seem completely real, and it would result in the form of extreme distress, panic, and terror. People experiencing psychosis would start hurting themselves in order to stop the symptoms. That’s why it’s significant to get professional help while experiencing psychosis.

Causes of Psychotic Depression 

Psychologists and experts are still working to find the exact single cause of MDD with psychosis or any other type of depression. Some of the main possible causes are as follows;

Environmental Factors

Experiencing highly stressful and traumatic events in your childhood would amplify your chances of getting depression.

Brain Chemistry & Biology

Imbalances in your brain chemicals like serotonin and dopamine level, and they play a significant role in your mental health. Studies have shown that higher stress hormones like cortisol also play an important in developing this condition.


If your close relatives like siblings or parents have depression, then it amplifies your chances of getting it.

Diagnosis of Psychotic Depression 

MDD with psychosis patients aren’t aware of their condition and they don’t know how to get help. It’s their close friends, relatives, and family members who observe the symptoms and make them get professional help. In order to diagnose the condition, your doctor would ask you a series of questions about your mood, emotional, and mental health. They would ask you questions like;

  • History of mental health, family, and personal health
  • Mental health symptoms like mania and anxiety
  • Health issues
  • Social relationship and support network
  • Facing problems while eating, sleeping, and other areas of life
  • Things you feel, hear or see that no one else notices it
  • Worries and beliefs that impact your life

The symptoms of psychosis aren’t always obvious, even professional clinical psychologists can’t diagnose it. They won’t immediately recognize the difference between rumination, fixed delusion, unwanted thoughts, dark, and pattern of the loop. Rumination and delusion are common in depression, and they comprise of following;

  • Thinking of yourself as a failed person, partner, or parent
  • Guilty feelings over something that you think that you did
  • Health concerns
  • Fears of rejections

You should explain all of your symptoms and signs in the form of beliefs, perceptions, and feelings to your doctor and he would make the right diagnosis.

Treatment of Psychotic Depression 

If a person is experiencing MDD with psychosis, then one should consult with a professional psychologist and therapist and get their help. It’s such a mental condition that won’t go away without professional help. Some of the main forms of treatments are as follows;


A simple therapy would be a good supportive approach, but it won’t alone help you to improve the signs of psychosis. It would offer you a space to share your distressing emotions and feelings. In the meantime, your therapist would offer you coping strategies to deal with delusions and hallucinations. Some of the main types of therapies are as follows;

  • Psychosis therapy and acceptance-based depression
  • Behavioral activation
  • Commitment therapy and acceptance
  • CBT (cognitive behavioral therapy)

Electroconvulsive Therapy

When MDD psychosis doesn’t respond with therapy and medication and the condition of depression of severe, then your therapist would recommend ECT. You would have to get it in the hospital under anesthesia. The treatment process comprises controlled voltage of electrical current repetitively in order to stimulate your brain. The electrical current would cause seizures impacting neurotransmitters in your brains at various levels.

ECT is an effective form of treatment for people experiencing Catatonia and having suicidal thoughts. Some of the main risks with the ECT risks are as follows;

  • Fatigue
  • Headache
  • Nausea
  • Short term memory loss

Your therapist or care team would inform you about the potential risks. ECT treatment won’t permanently stop the signs of psychosis. It is possible that your doctor would suggest ongoing ECT treatment with medication.


The medical treatment of MDD with psychosis comprises of antipsychotic and antidepressants or both in combination. Your therapist would suggest SSRI (selective serotonin reuptake inhibitor) along with the following antipsychotic medicines;

  • Risperidone
  • Quetiapine
  • Olanzapine

Conclusion: What is Psychotic Depression? Symptoms, Causes, Treatment 

After an in-depth study of what is psychotic depression; its symptoms, causes, diagnosis, and treatment; we’ve realized that MDD with psychosis is a severe depressive condition. If you observe its symptoms on any of your close ones, then you should help them to receive professional help.