Major depression with psychotic features

Answer 1

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 (hallucinations).

See also:

• Major depression
• Psychosis

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. People with psychotic depression have the combined 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. People may develop feelings that their body is filled with cancer, or is "rotting inside." 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.

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

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 guidelines for the treatment of patients with major depressive disorder. 2nd ed. September 2007. Accessed January 22, 2010.

Answer 2

Definition

Major depression with psychotic features is a mental disorder in which a person has depression along with loss of touch with reality (psychosis).

See also:

• Major depression
• Psychosis

Alternative Names

Psychotic depression; Delusional depression

Causes, incidence, and risk factors

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

Signs 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 doctor 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.

Expectations (prognosis)

This is a serious condition that requires immediate treatment and close monitoring by a doctor. 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 the psychotic symptoms.

Complications

The risk of suicide is much higher in people with depresison 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 others must also be considered.

Calling your health care provider

If you have thoughts of suicide or harming yourself or others, immediate 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 doctor 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 consulting your doctor.

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.

Reviewed By

Review Date: 02/24/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 3

Major depressive disorder with psychotic features is a specific subtype of depression that includes experiences such as hallucinations and delusions. Treatment usually involves a combination of medication (such as antidepressants or antipsychotics) and therapy (such as cognitive-behavioral therapy or dialectical behavior therapy). It is important to seek help from a mental health professional for proper diagnosis and treatment.