Psychotic Depression: 7 Essential Tips to Overcome It

Introduction

Depression is a common psychiatric condition where a person feels sad and hopeless almost every day in his life, along with a lack of interest in activities, fatigue, poor focus, sleep and appetite problems, and thoughts of dying. Psychotic depression is a much more severe form of depression where a person begins to lose touch with reality. 

Psychotic Depression

Psychotic depression, also known as a major depressive disorder with psychotic features, is a serious form of depression where a person suffers from not only the symptoms of depression but also those of psychosis, such as delusions and hallucinations. It affects approximately 15-20% of the individuals who go through depression and is even more common in depression in older people, with rates as high as 53% (Rothschild et al., 2013). Apart from this, many individuals can also experience psychotic depression as a part of bipolar disorder. Because of the severe nature of the illness, those suffering from psychotic depression are at a high risk of attempting suicide. 

Symptoms of Psychotic Depression

1. Individuals with psychotic depression experience the classic symptoms of depression that affect their mood, energy levels, thinking, sleep, and appetite.
2. Apart from these, a person also experiences psychotic features such as delusions (strong beliefs that are not real) or hallucinations (seeing things or hearing voices that are not real). 
3. The beliefs are generally depressing and reflect their underlying mood. For example, a person might start believing that they have developed a serious illness such as cancer or HIV AIDS or that they have done something very wrong and need to be punished. Sometimes, they might also believe that the world has ended or that they are dead or dying. These beliefs are very strong and can affect their day-to-day life. 
4. The hallucinations are less common and can be in the form of voices that tell the sufferers that they have done something bad and deserve to die/or be punished. 
5. Secondary to these distorted experiences, individuals can become extremely distressed and agitated. 

Major Depression with Psychotic Features

1. Major depression with psychotic features is another term to describe psychotic depression. Hence, both are essentially the same illnesses and imply a very severe form of depression where a person begins to develop rigid, distorted beliefs (in short, delusions) and experiences things that other people around him are not able to (in short, hallucinations). 
2. These experiences and beliefs are secondary to difficulty in differentiating between what is real and what is not and can make the person behave in very strange and erratic ways. 
3. For example, some individuals might develop a belief that they have already died or their internal organs have stopped working. Secondary to this, they might refuse to eat or refuse to move around and engage in day-to-day activities. 
4. They might even hear voices that talk to them or command them to do things. As a result, the individual can be at risk of harming themselves or, rarely, people around them.

7 Essential Tips to Overcome Psychotic Depression

1. Seek Help: People with psychotic depression might often be unaware they’re thinking and acting strangely. So, if you feel someone you know might be going through it, do not hesitate to seek help for them. 
2. Hospitalization: Psychotic depression requires immediate treatment and, in many cases, initial hospitalization.
3. Professional Help: In case of suicidal thoughts, reach out to a family member, friend, or a mental health professional at the earliest and seek prompt treatment for the same.
4. Medication: A combination of medications will initially be required to reduce the symptoms and manage the illness.
5. Electroconvulsive therapy: Electroconvulsive therapy, or ECT, has shown excellent results in psychotic depression. So, if your doctor recommends it for you or your relative, discuss and consider it. 
6. Physical activity: As the condition improves, your doctor might recommend exercise or other forms of physical activity. These will aid in recovery.
7. Do not stop treatment: Do not change or stop any treatment without first talking to your doctor, as it can lead to sudden worsening of symptoms or side effects.

Psychotic Depression Treatment

• Medication: Psychotic depression, being a serious illness in most cases, requires a combination of medical and non-medical treatment. With respect to medications, generally, a combination of antidepressants and antipsychotics may be required to help bring the illness under control and stop the distorted experiences (Rothschild et al., 2016). In some cases, such as when psychotic depression is a part of bipolar disorder, another type of medication called mood stabilizers may also be recommended. 
• Electroconvulsive therapy (ECT): In a few cases, electroconvulsive therapy (ECT) may be recommended by your doctor as a treatment option. This is particularly in cases where the person has a very severe illness leading to suicidal thoughts/ attempts or when medications by themselves have not shown a good response. ECT is a safe form of treatment that has shown excellent efficacy in psychotic depression, particularly in the elderly (Rothschild et al., 2016). 
• Hospitalization: In the initial phases of treatment, hospitalization may be required to provide a safe environment to the patient and to hasten recovery. 
• Psychotherapy: As the person improves, psychotherapy, commonly known as talk therapy, may also be required to help the person identify and work on their problematic thoughts.

Conclusion

In conclusion, psychotic depression is a severe type of psychiatric illness that can cause a lot of disruption in one’s life. In some cases, it can be potentially life-threatening due to the morbid nature of the sufferer’s experiences. Due to a loss of touch with reality, individuals having psychotic symptoms might sometimes be unaware that their strange thoughts, feelings, and emotions are part of an illness. As a result, family members, friends, or other carers are an important part of the treatment. A variety of treatment options, such as medications, ECT, and psychotherapy, are available and have been found to have good results. With proper treatment and regular follow-ups, individuals often respond well and can lead normal, healthy lives.

 References:

Rothschild AJ. Challenges in the treatment of major depressive disorder with psychotic features. Schizophr Bull. 2013 Jul;39(4):787-96. doi: 10.1093/schbul/sbt046. Epub 2013 Apr 18. PMID: 23599251; PMCID: PMC3686458.

Rothschild AJ. Treatment for Major Depression With Psychotic Features (Psychotic Depression). Focus (Am et al.). 2016 Apr;14(2):207-209. doi: 10.1176/app.focus.20150045. Epub 2016 Apr 7. PMID: 31975804; PMCID: PMC6519655.