Mental Health Conditions

Psychotic Depression

Psychotic depression occurs when people who have severe, clinical uni-polar depression (which may also be called ‘major depressive disorder’) experience the symptoms of psychosis.

Symptoms of Psychotic Depression
Symptoms of psychotic depression include hallucinations and delusions. The delusions tend to be very negative and self-blaming, and can make people feel even more anxious.

People with psychotic depression can also experience ‘psychomotor agitation’ – an inability to relax or sit still. They may rock, fidget, or move their legs a lot, for example. Being acutely and severely anxious, often as a result of the symptoms of psychosis, contributes to the psychomotor disturbance.

It may be difficult to diagnose psychotic depression. The symptoms of psychosis may be subtle, and people may sometimes not report that they are experiencing hallucinations and delusions because they are embarrassed or frightened by them.
There is a danger too of misdiagnosis – If people are experiencing psychomotor agitation, for example, their symptoms could be attributed to severe anxiety.

Treatment for Psychotic Depression
People who have psychotic depression will be referred to a specialist mental health service. Some may need hospital treatment. Alternatively, they may be under the care of a home treatment team.

Treatment initially concentrates on the depression, rather than the symptoms of psychosis. People will normally already be taking medication for severe depression – antidepressants, or a combination of medication which may include antidepressants, mood stabilisers and medication to counter anxiety. Talking therapies may be used to treat depression in addition to medication.

Anti-psychotic medication may also be prescribed, depending on the individual’s circumstances and needs.

Psychotic depression is one of the few illnesses where ECT (electroconvulsive therapy) may still be used as a treatment.

SANE offers emotional support and information to anyone affected by psychotic depression, including family, friends and carers. If you or anyone you know may be affected, you can receive free mental health support via our Textcare and Support Forum services. Our helpline is also available on 0300 304 7000 6 pm – 11 pm.