Major depression with psychotic features

Causes

The cause is unknown. A family or personal history of depression or psychotic illness makes you more likely to develop this condition.

Symptoms

People with psychotic depression have symptoms of depression and psychosis.

Psychosis is a loss of contact with reality. It usually includes:

• Delusions: False beliefs about what is taking place or who one is
• Hallucinations: Seeing or hearing things that aren't there

The types of delusions and hallucinations are often related to your depressed feelings. For example, some patients may hear voices criticizing them, or telling them that they don't deserve to live. The person may develop false beliefs about their body, for example that they have cancer.

For information on symptoms of depression, see: Major depression

Exams and Tests

Your health care provider will perform a physical exam and ask questions about your medical history and symptoms. Your answers and certain questionnaires can help your health care provider diagnose this condition and determine how severe it may be.

Blood and urine tests and possibly a brain scan may be done to rule out other medical conditions with similar symptoms.

Treatment

Psychotic depression requires immediate medical care and treatment.

Treatment usually involves antidepressant and antipsychotic medication. You may only need antipsychotic medication for a short period of time.

Electroconvulsive therapy can help treat depression with psychotic symptoms. However, medication is usually tried first.

Outlook (Prognosis)

This is a serious condition. You will need immediate treatment and close monitoring by a health care provider.

You may need to take medication for a long time to prevent the depression from coming back. Depression symptoms are more likely to return than psychotic symptoms.

Possible Complications

The risk of suicide is much higher in people with depression with psychotic symptoms than in those without psychosis. You may need to stay in the hospital if you have thoughts of suicide. The safety of other people must also be considered.

When to Contact a Medical Professional

If you have thoughts of suicide or harming yourself or others, immediately call your local emergency number (such as 911) or go to the hospital emergency room.

You may also call a suicide hotline from anywhere in the United States, 24 hours a day, 7 days a week: 1-800-SUICIDE or 1-800-999-9999.

Call your health care provider right away if:

• You hear voices that are not there.
• You have frequent crying spells with little or no reason.
• Your depression is disrupting work, school, or family life.
• You think that your current medications are not working or are causing side effects. Never change or stop any medications without first talking to your health care provider.

Alternative Names

Psychotic depression; Delusional depression

References

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 guideline for the treatment of patients with major depressive disorder, third edition. Arlington (VA): American Psychiatric Association; 2010 Oct. 152 p.

Update Date: 2/13/2012

Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.