Depression is bad enough. However, it can be worse. You could have psychosis along with your depression. Psychotic depression is also called depression with psychosis, depressive psychotic disorder or major depressive disorder with psychotic features. No matter what you call it, psychosis and depression are not exactly two tastes that go great together.
According to the National Institute of Mental Health (NAMI), psychotic depression is a mental illness where someone has both the symptoms of major depression and a psychotic disorder. Major depression is bad, but usually not a medical emergency unless the person is trying to commit suicide. Psychotic depression is a medical emergency. Anyone showing signs of a psychotic disorder needs immediate hospitalization.
What is Psychotic Disorder?
A psychotic disorder can pop up in many people suffering from mental illnesses. It’s most commonly seen in schizophrenics, but can also be seen in patients with bipolar disorder, postpartum depression or major depression. People who are psychotic are suffering from such an onslaught of hallucinations that they can no longer determine what reality is.
This is a scary place to be. It’s also scary for anyone living with someone going through a psychotic episode. Psychotic people are seeing things that aren’t there, hearing things that aren’t there, feeling things that aren’t there and sometimes even smelling things that aren’t there. It’s very hard to convince someone in the grips of a psychotic episode that they are “merely” hallucinating. The hallucinations seem as real as reality.
What is Depression?
Depression is a word with multiple meanings ranging from a brief temporary state of “the blues” to a life-long feeling of worthlessness and hopelessness. The former type of depression is not a mental illness. The latter is. In order to distinguish between the two types, doctors and mental health professionals call it major depression, clinical depression or endogenous recurring depression.
Depression is an incurable but treatable mental illness. It is not a character flaw or a sign of weakness. Treatment usually lasts for the rest of the patient’s life. People of all ages, including young children, can get depression. Not everyone who is diagnosed with depression will suffer from psychotic episodes. Common depression symptoms include:
- Sleeping too much or sleeping too little
- Eating too much or eating too little
- Giving away prized possessions
- Lack of interest in anything that used to give joy
- Belief that they are so hopeless that they cannot be helped
- More talk than usual about death, dying or suicide
- Suddenly doing poorly at work or school
- Inability to make decisions or learn new things
- Extreme irritability.
Causes of Psychotic Depression
Doctors would give a lot to know the answer to the question “What is psychotic disorder caused by?” The more we discover about mental illness, the more mysterious it seems. There is n known cause for psychotic depression. It is unknown why some people with depression get it while others with depression do not. There are no diagnositc tests for psychotic depression.
There may be genetic reasons for psychotic depression, but these reasons are unclear. It is known that psychosis and depression can run in families. However, even a child of two parents with psychotic depression may not develop psychotic depression. Brain tumors and severe illnesses can cause psychotic episodes, so a doctor may insist on a patient getting a brain scan and other medical tests when he or she suffers the first psychotic episode.
Signs and Symptoms of Psychotic Depression
The signs and symptoms of a psychotic episode differ for each person, but they all have serious issues getting along with reality. These signs and symptoms include:
- Hearing voices that are as loud as a radio or television
- Extreme paranoia with no concrete evidence to back up this paranoia
- Talk of committing suicide
- Talk of bizarre beliefs that seem to come out of nowhere, such as a belief that aliens are persecuting them
- Seeing things that are not there
- Extreme anxiety or agitation
- Cannot be persuaded that their sudden strange beliefs are wrong
- Crying or laughing fits that last hours or even days
- Inability to make decisions
- Catatonia, or an inability to move or speak.
How bad can psychosis get? People in the grips of a psychotic episode have been known to accidentally fall off roofs, commit suicide, set their homes accidentally on fire and even kill others. Psychotic episodes always get worse over time if not treated.
Treatment of Psychotic Depression
The first goal of treatment is to remove or reduce the hallucinations gripping the patient. Medication is usually tried first. Drugs may be combined with therapy. Patients will be prescribed at least two drugs. The most common drugs used to treat psychotic depression are:
- Tricyclic antidepressants
- Antipsychotic drugs such as amitriptyline
- RU-486, better known as “the abortion pill.” This is an off-label use for the drug.
If it does not work, then shock therapy, also known as electroconvulsive therapy (ECT) is tried. ECT has come a long way since the famous film One Flew Over the Cuckoo’s Nest (1975), as described in detail in the fascinating book Shock: The Healing Power of Electroconvulsive Therapy (Avery; 2006.) Patients are put in padding and put under anesthesia before they get “shocked.” The benefits are short-term, so ECT treatments last for months or years.
Prognosis of Psychotic Depression
The good news is that symptoms of psychosis often go away within a year of beginning treatment. The bad news is that symptoms of depression are much tougher to manage. Keep in mind that there is no cure for psychotic depression. Symptoms can be managed, but they can come back. There is a high chance that psychotic symptoms will return sometime in the person’s life.
It’s important for loved ones and caretakers of people with psychotic depression to be on the lookout for the first symptoms of a psychotic episode. If a person begins these symptoms, then the caretaker needs to call the person’s psychiatrist or doctor for advice. Depending on what medical facility the person uses, a doctor may need to call in advance to help set the patient up for treatment at that facility.
For Parents: To Tell or Not to Tell?
Parents are understandably reluctant to tell anyone that their beloved child has psychotic depression. Not everyone needs to know about your child’s mental health. However, it is good to let the child’s school know about the diagnosis. Babysitters should also be told, especially if they are to administer medication to the child.
Any doctor, specialist or medical personnel should be told, especially if they want to prescribe new medications to the child. These new medications cannot clash with the medications taken to control the psychosis. Your child may not want friends or classmates to know about his or her mental illness. Respect that request as much as you can as long as it does not impact your child’s safety.
“Mommy, What is Psychotic Disorder?”
All close family members should be aware of a relative’s mental illness. Explaining this can be very hard for the parents of young children. The best way to do it is just to do it. You know your child better than anyone else. You know what he or she can understand and what he or she cannot. Children will probably ask if they will get psychotic depression, too. It’s best to tell them the truth – that we don’t know, but maybe someday we will.
It is good to let the children know that the family member with psychotic depression will likely be teased or somehow treated badly by others. People with mental illness are still ostracized by society. Explain to your children that your relative cannot help having psychotic depression just as you cannot help getting the flu or getting cancer.
The Dangers of Self-Medication with Psychotic Depression
It is normal for a mentally ill person to not want to take their medications. It seems somehow humiliating to have to rely on chemicals in order to be “normal.” Many patients are tempted to stop taking their medications when they feel good. They falsely believe that they are cured. However, there is no cure. They still need to take their medications in order to feel good.
Some mentally ill patients try to control their symptoms through street drugs and alcohol. They may temporarily feel that they are okay, but this is an illusion. Over time, street drugs and alcohol will greatly worsen an already bad situation as the person becomes addicted to this new substance. Alcohol and street drugs can also greatly interfere with any life-saving medications that the person needs to take.