Psychotic Depression

Psychotic depression is another sub-type of major depressive disorder. How it differs from other types of depression is that those with psychotic depression will experience delusions and hallucinations.

The delusions and hallucinations will usually reflect the mood of the person. They may believe they have committed a crime or that they are to blame for something. They may believe others can hear their thoughts, or they are possessed. The hallucinations are also not necessarily just visual; they can be in the form of voices that the person hears. What separates psychotic depression from other mental illnesses with hallucinations is that psychotic depressives are usually aware they are not real.

Those with psychotic depression may become enraged for no apparent reason. They may also spend a lot of time in bed, isolated from others. The risk of suicide is much higher in people with psychotic symptoms than in those without, and they may be hospitalised.


Psychotic depression is treated with combinations of tricyclic antidepressants and antipsychotic medications. These have been most effective in easing symptoms. Similar to melancholic depressive disorder, psychotic depression is a ‘treatment resistant’ form of depression, and one of the few illnesses where ECT (electro-convulsive therapy) may still be used, and it is a very effective one at that. Cognitive therapy may be used at a later stage of treatment, but is unlikely to be effective enough on it’s own.

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