Depression:
Psychotic Depression

What Is Psychotic Depression?

Roughly 25% of people who are admitted to the hospital for depression suffer from what's called psychotic depression. In addition to the symptoms of depression, psychotic depression includes some features of psychosis -- like hallucinations (seeing or hearing things that aren't really there) or delusions (irrational thoughts and fears).

How Is Psychotic Depression Different Than Other Mental Illness?

While people with other mental illness, like schizophrenia , also experience these symptoms, those with psychotic depression are usually aware that these thoughts aren't true. They may be ashamed or embarrassed and try to hide them, sometimes making this type of depression difficult to diagnose. Having an episode of psychotic depression increases your risk of bipolar depression, recurring episodes of psychotic depression, and suicide.

What Are the Symptoms of Psychotic Depression?

Symptoms that occur commonly in psychotically depressed patients include:

• Anxiety
• Agitation
• Hypochondria
• Insomnia
• Physical immobility
• Constipation
• Intellectual impairment
• Psychosis

How Is Psychotic Depression Treated?

Treatment for psychotic depression requires a longer hospital stay and close follow-up by a mental health professional. Combinations of antidepressants and antipsychotic medications have been most effective in easing symptoms. Electroconvulsive therapy (ECT) may also be used to treat psychotic depression.

What Is the Outlook for People With Psychotic Depression?

Treatment is very effective for psychotic depression, and people are able to recover, usually within a year, but continual medical follow-up may be necessary. It is important, however, that a person experiencing these symptoms be properly diagnosed because treatment is different than for other major depressive illnesses and risk of suicide is greater.

Reviewed by the doctors at The Cleveland Clinic Department of Psychiatry and Psychology.

Medically reviewed by Cynthia Haines, MD, July 2005.

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Last Editorial Review: 11/28/2005