Psychotic Depression: Symptoms, Diagnosis and Treatment
Psychotic Depression occurs when a person who is
depressed goes on to develop psychotic symptoms such as delusions, hallucinations and depressive
stupor, where a person, although conscious, becomes almost entirely unresponsive. I’m
Dr Beth Colby, a psychiatrist in London. People with severe depression have a depressed
mood, loss of interest and enjoyment in activities that they’d normally find enjoyable, and reduced
energy leading to increased fatigability and diminished activity, with marked tiredness after
even slight effort. The individual usually shows marked distress or agitation – where they are
unable to relax and sit still, or are constantly fidgeting – or retardation – where their thoughts
or actions are slowed down. People may have a very low self-esteem and feelings of uselessness
or guilt, and suicide is a distinct danger, particularly in severe cases. It is presumed that
somatic syndrome will almost always be present. For a diagnosis of severe depression, as well
as having the symptoms I’ve already described, individuals will have four of the following
symptoms: reduced concentration and attention, reduced self-esteem and self-confidence, ideas
of guilt and unworthiness, bleak and pessimistic views of the future, ideas or acts of self-harm or
suicide, disturbed sleep, disturbed appetite – and the depressive episode should usually last at
least 2 weeks. Studies suggest that of those who experience severe depression, 14.7 -18.5 % of
these will go on to develop psychotic depression. As we do not know enough about the condition,
it is impossible to predict who will get this. However, psychotic depression is more common
as people get older. It is likely, though, that a specific combination of genes – such as
those responsible for causing depressive symptoms, plus those responsible for causing psychotic
symptoms – in combination with the environment, are responsible for the condition. In psychotic
depression, the delusions are usually mood congruent – that is, the false beliefs reflect
the depressed mood. These are usually negative, involving ideas of sin, guilt, poverty,
hopelessness, failure, and the individual may believe that they’ve been responsible for a
terrible crime or disasters, leading to increased anxiety and possible increased psychomotor
agitation. The hallucinations are usually auditory or olfactory. The voices are usually defamatory
or accusatory, and the olfactory hallucinations include smells of rotting filth or decomposing
flesh. Severe psychomotor retardation may progress to depressive stupor, where, although
the person is conscious, aware and alert, they are motionless and virtually unresponsive to
stimuli except for intense stimuli such as pain. This is very uncommon now, though, due to modern
treatments. A person may be so ill with psychotic depression that they require treatment in
hospital, usually for their safety or for their health, including physical. Alternatively,
they may be under the care of a Home Treatment Team. The person will usually already be on
antidepressant medication, and antipsychotic medication will be commenced when the person
experiences psychotic symptoms. This combination of antidepressant medication and antipsychotic
medication has been shown to be significantly more effective than antidepressant medication, or
indeed antipsychotic medication, on their own. ECT is a safe and highly effective treatment for those
people who do not respond to medication. This includes those who have severe suicidal thoughts
and also those who may be dehydrated due to decreased oral intake. However, after the ECT
treatment, to prevent a recurrence of symptoms, a person will need to take ongoing treatment
of antidepressants. Psychological therapies may be used – although, when a person is very
unwell, particularly with their concentration, it may be initially difficult to engage in this.
Patients of course will need social support and close follow-up for monitoring of their
condition. Thank you for listening. ‘Bye for now.
Psychotic depression occurs when an individual with severe depression experiences psychotic symptoms, such as delusions and hallucinations, or experiences depressive stupor, where the individual is so slowed down with psychomotor retardation such that they are almost entirely unresponsive. I use ICD-10 to outline the diagnosis, and talk about the symptoms and treatment using other texts as well.
I am Dr Beth Colby, a psychiatrist in London. Other videos on my Talk Mental Health channel include:
Common Mental Health Conditions:
10 Symptoms of Depression
10 Tips for Self Help for Depression (in 2 parts)
Treatments for Depression/What will Happen if I tell my Doctor I am Depressed?
What is Anxiety?
What is Generalised Anxiety Disorder?
Positive and Negative Symptoms of Schizophrenia
Paranoia: Paranoid Schizophrenia, Persistent Delusional Disorder and Paranoid Personality Disorder
Bipolar Affective Disorder Explained
What is Autism?
Autistic Spectrum Disorder ICD-11 v ICD-10 v DSM-5
What is Panic Disorder?
What are Panic Attacks?
What is Mania?
Paranoid Personality Disorder
Histrionic Personality Disorder
Anxious Avoidant Personality Disorder
Dependent Personality Disorder
Schizoid Personality Disorder
Emotionally Unstable Personality Disorder
Anankastic Personality Disorder
Psychiatric Terminology
Psychotic Disorders, Affective Disorders and Neurotic Disorders
What Happens When Somebody is Sectioned?
Sections 2 and 3 of the Mental Health Act
Who is My Nearest Relative?
Current Mental Health Issues and News
Suicides in Afghan Veterans
Coronavirus Panic
Coping with Coronavirus Anxiety
Coronavirus will Harm People’s Mental Health
Loneliness
PTSD in COVID-19 NHS Staff
Eco-Anxiety
‘Mini Versions’, under 2 minutes long, of my videos include:
10 Symptoms of Depression
10 Tips for Self Help for Depression
Positive and Negative Symptoms of Schizophrenia
Anxiety
Mania
Anxious Avoidant Personality Disorder
Paranoid Personality Disorder
Schizoid Personality Disorder
Histrionic Personality Disorder
Dependent Personality DIsorder
Translated videos include:
Into Kurdish:
What is Anxiety?
10 Symptoms of Depression
Into Farsi:
What is Anxiety?
10 Symptoms of Depression
If you would like me to do videos on any other topics, or have any questions, please write a message in the comments section.
15 Comments
Go easy on yourself if you're experiencing more depression or anxiety than usual. You're not alone in your struggles. Maintain a routine as best you can. Even if you're stuck at home, try to stick to your regular sleep, school, meal, or work schedule. This can help you maintain a sense of normalcy.
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I was diagnosed with this in a mental hospital. It's a horrible illness.
Very well explained.
Hi Mam,my mind says that I cannot do well in the area where I am interested,passionate and talented..but actually I can do.
I am good at speaking English but my mind tells me that I can't speak english.
I am interested,passionate and capable to study well and succeed in IT field by studying MCA but my mind tells me that I can't study mca,don't have ability and many other negative thought regarding this.. and many more places were I am capable and good at but my mind tells I can't
So is this the symptom of depression or my personality??please reply mam I'm worried about this😢
I like the way you explained this disorder compared to others who explained it.
Other Videos such as this example (https://youtu.be/SZhJsalR7qg) feel extremely forced, as if the person talking is forced to say that. It's very distressing since it can affect your delusions/ your delusions using this as an example why to believe them.
This one (https://youtu.be/H_vW3GxAKIc), staring 4:50, talks about how they [mental health professionals] are not bad people, we [mentally unwell people] have to make the first step and how they'll take us from there. Personally, the delusional part of my brain (or how else shall I call it?) kept on trying to make me feel that you [mental health professionals] are actually just bad people trying to make us give ourselves to you with these videos (that feel like propaganda) that are supported by the government to use us [civilians] as lab rats. I know it's not true, I can most of the time talk myself out of it when I am more stable (/not in an episode) but regardless it is very distressing.
I generally like the way you talked about it, am thankfu for this video and it is far less triggering than others as I mentioned before.
Or perhaps I am just not stable enough to hear examples of Delusions. I should write this down for my next therapy session probably.
My wife was diagnosed with this but covert narcissist fits her like a glove.
Electro convulsive therapy??? Jeez. Im out
I have seen this type of depression during a time while the person was 5 day binge drinking
Been there done that,
To be honest I have had health issues since I was a little child because of the stressful environment I was raised in, as I learned after growing up that I really was a Highly sensitive person, then when I got 16 years old I got IBS then ulcers then depression then after some years when I was 22 years old I had my sciatica nerve compressed due to IBS because due to digestion and bowel movement issues I developed pelvic tilt and when I lifted weight which my job required at that time my sciatica nerve was compressed then I lost my father then had Typhoid then I had and accident in which I got my back bone damaged, a weight from a construction site fell on my head which compressed 4 of my thoracic spine discs along with 9 stitches on my forehead then more depression because the company where I worked diched me, then I had hepatitis c and at hepatitis when I almost gave up and was ready to die I started smoking which helped tremendously, and now I am out of depression and most of the illnesses and conditions but I have low energy all the time along with constipation and 4 thoracic spine discs compressed and I get brain fog a lot, I can't feel anymore, not the happiness, not the sadness, not the anger and not any motivation, I'm completely unorganized, I struggled this all for my father but I failed, now I've mostly made my peace with my past , I have reserved myself subconsciously as a defense mechanism, had to deal with a lot of grief, now I want to get back up but how can I? why would I? Now I'm 24 with empty pockets, can't support my mother and brothers, lost all dreams, don't have anyone to look up to, I am hollow inside, I am always on low energy, I can’t remember my childhood mostly it was sad anyways, I've had health problems since I can remember living, now my tongue had mostly lost the sense of taste and I've also mostly lost my sense of smell I also cannot exercise because of my back injuries and all of this combined had taken a toll on me, I'm also overweight now, I was once a professional MMA fighter but I also had to quit that, that was one of the most strong purpose of my life, I live in a 3rd world country, my age is slipping away and by the time I recover, if that happens my age would be too much to fulfill anything, I'm in my prime age of 25 and completely wrecked. My life has not been a journey, just nightmare and there is no waking up from it. It's not about recovering It's why would I. I can only live as long as I have a purpose, I'm a human who operates on purpose I know I can never be the person I used to be.
There is something called Amphetamine Supersensitivity Psychosis. A Supersensitive brain will develop psychosis from what others would consider a low dose. My experiences of depressive psychosis were terrible. Constant teminders that my brain was sick and lying to me were helpful.
It baffles me that there aren't any examples on YouTube of a patient suffering from catatonia or psychomotor retardation
Clinical Depression is bad enough…had it twice…literally health on earth.🔥🔥🔥
I lost my job just because of pshcotic depression
I could see a situation where docs misdiagnosed the person with syzoprenia instead.
Grossly underviewed. I try to find more about this very rare type of depressive disorder and most videos will discuss psychosis and depression seperately. This was very insightful and the only video that clearly specifies depression with psychotic symptoms (a long with the mood congruent hallucinations and delusions). Thanks a lot!