Major depression with psychotic features

• Alternative Names

  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.

• Symptoms

  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. Psychotic depression requires immediate medical attention to prevent self-harm or harm to others.

• Signs and tests

  Diagnosis involves:

  • 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

  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.

• Expectations (prognosis)

  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.

• Complications

  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.

• References

  Jarema M. Atypical antipsychotics in the treatment of mood disorders. Curr Opin Psychiatry. 2007;20:23-29.

Review Date: 1/15/2009

Reviewed By: Christos Ballas, MD, Attending Psychiatrist, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.