Psychotic depression

Some people who have severe depression also experience symptoms of psychosis. The most common of these are hallucinations and delusional thinking.

When someone has psychotic depression, they often can't accept that the thoughts they're having are caused by the condition. This can be frightening for the person, and for their loved ones too.

Depression with psychosis is known as psychotic depression.

Severe clinical depression can make you feel:

• sad and hopeless for most of the day
• like you have no interest in anything
• that it's impossible to get through the day

You may have these feelings nearly every day.

Other symptoms include:

• fatigue (exhaustion)
• losing pleasure in things
• not being able to concentrate
• difficulty making decisions
• sleep problems
• changes in appetite
• feeling guilty
• feeling worthless
• having thoughts about suicide, or death

Moments of psychosis are called psychotic episodes. If you have a psychotic episode, you may have:

• delusions, which are unshakeable beliefs or thoughts that are likely to be false
• hallucinations, which means hearing, seeing, or sometimes smelling, feeling or tasting things that aren't there

In psychotic depression, hallucinations and delusions almost always reflect the pessimism and guilt of the person going through them. They may believe they have committed a crime, or that they are to blame for something.

You might also have something called psychomotor agitation. This can make you feel you can't sit still or relax, and it causes fidgeting.

The opposite can happen too. Psychomotor retardation can make your thoughts and the movement of your body slow down.

If you have psychotic depression, you might be at a higher risk of thinking about suicide.

Doctors don't yet fully understand what causes psychotic depression. What they do know is that depression never has just one cause. A lot of different things can trigger it.

Stressful events in life, such as divorce, money worries or the death of someone close, can bring on depression.

Severe depression can run in families, which suggests that genes may play a part. But nobody knows why some people with severe depression also develop psychosis.

Many people with psychotic depression went through a difficult time in childhood. For some, this was a traumatic event.

Treatment for psychotic depression has 3 main parts:

• medication: taking a combination of antipsychotics and antidepressants can help
• psychological therapies: cognitive behavioural therapy (CBT) is a talking therapy that can help treat psychosis
• social support: help with social needs like employment, education and accommodation

You may need intensive home treatment, with several visits a day from a healthcare professional, or you may have to spend some time in hospital.

Electroconvulsive therapy (ECT, or electric shock treatment) might be recommended if other treatments haven't helped.

Treatment for psychotic depression is usually effective, but you'll still need follow-up appointments. These let your treatment team keep monitoring your progress.

Often it's friends, relatives or carers who have to seek help for a person with psychotic depression. People with psychosis frequently don't realise they're acting and thinking strangely, so they may not ask for help themselves.

If you're worried someone might be experiencing psychosis, contact their:

• community mental health team or social worker, if they have one
• doctor, or take them to the hospital emergency department

If you think the person's symptoms are putting them at risk, you can:

• take them to the nearest hospital emergency department, if they agree
• phone their doctor, or a doctor or the 16263 health line if the doctor's chamber is closed
• in an emergency, phone 999 and ask for an ambulance