Health Encyclopedia

Major depression with psychotic features

Definition

Major depression with psychotic features is a condition in which a person experiences depression along with reduced contact with reality (psychosis). This can take the form of false beliefs (delusions) or seeing or hearing something that isn't really there (hallucination).

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. The symptoms of psychotic depression are a combination of 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 and continuing to do well.

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

International early psychosis association writing group. International clinical practice guidelines for early psychosis. Br J Psychiatry, 2005;187:s120-s124.

Review Date:2/6/2008
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.

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