Depression (clinical) - Psychotic depression

Some people who have severe clinical depression will also experience hallucinations and delusional thinking, the symptoms of psychosis.

Depression with psychosis is known as psychotic depression.

What are the symptoms of severe depression?

Having severe clinical depression means feeling sad and hopeless for most of the day, practically every day, and having no interest in anything. Getting through the day feels almost impossible.

Other typical symptoms of severe depression are:

fatigue (exhaustion)
loss of pleasure in things
disturbed sleep
changes in appetite
feeling worthless and guilty
being unable to concentrate or being indecisive
thoughts of death or suicide

What are the symptoms of psychosis?

Having moments of psychosis (psychotic episodes) means experiencing:

delusions – thoughts or beliefs that are unlikely to be true
hallucinations – when a person hears (and in some cases feels, smells, sees or tastes) things that aren't there; a common hallucination is hearing voices (read more about hallucinations and hearing voices)

The delusions and hallucinations almost always reflect the person's deeply depressed mood – for example, they may become convinced they're to blame for something, or that they've committed a crime.

"Psychomotor agitation" is also common – this means not being able to relax or sit still, and constantly fidgeting.

Or, at the other extreme, a person with psychotic depression may have "psychomotor retardation", where both their thoughts and physical movements slow down.

People with psychotic depression are at greater risk than normal of thinking about suicide.

What's the cause?

The cause of psychotic depression is not fully understood. What we do know is that there's no single cause of depression and it has many different triggers.

For some, stressful life events such as bereavement, divorce, serious illness or financial worries can be the cause.

Genes probably play a part, as severe depression can run in families, although it's not known why some people also develop psychosis.

Many people with psychotic depression will have experienced adversity in childhood, such as a traumatic event.

Learn more about the causes of clinical depression.

How is it treated?

Treatment for psychotic depression involves:

medication – a combination of antipsychotics and antidepressants can help relieve the symptoms of psychosis
psychological therapies – the one-to-one talking therapy cognitive behavioural therapy (CBT) has proved successful in helping some people with psychosis
social support – support with social needs, such as education, employment or accommodation

The patient may need to stay in hospital for a short period while they're receiving this treatment.

Sometimes electroconvulsive therapy (ECT) may be recommended if the patient has severe depression and other treatments, including antidepressants, haven't worked. Read more about ECT.

Treatment is usually very effective, although patients may need to be continuously monitored in follow-up appointments.

Getting help for others

People with psychosis are often unaware that they're thinking and acting strangely.

Because of this lack of insight, it's often down to the friends, relatives or carers of a person affected by psychosis to seek help for them.

If you're concerned about someone you know and think they may have psychosis, you could contact their social worker or community mental health nurse if they've previously been diagnosed with a mental health condition.

If this is the first time they've shown symptoms, contact their GP or take them to A&E.

If you think the person’s symptoms are placing them at possible risk of harm you can:

take them to the nearest accident and emergency (A&E) department, if they agree
call their GP or local out-of-hours GP
call 999 and ask for an ambulance

Support and advice

More information on psychosis

SANE

Supporting someone who has experienced psychosis

Mind