Depression occurs along with psychosis, a transient psychological state characterized by abnormal perceptions, which will include delusions and hallucinations. When psychosis accompanies major depression, it’s called depressive disorder or depression with psychosis. It’s estimated that anywhere from 14% to almost 50% of individuals diagnosed with depression have a depressive disorder, and geriatric patients are especially prone to it.
Psychotic depression is taken very seriously by psychological state professionals because the individual affected by it is at an increased risk of self-harm.
“The suicide rate in people with depressive disorder, once they are ill and in their acute phase, is far above it’s with major depression,” says Anthony J. Rothschild, MD, the Irving S. and Betty Brudnick Endowed Chair, Professor of Psychiatry at the University of Massachusetts school of medicine in Worcester, Massachusetts.
It’s essential to differentiate depressive disorder from psychosis, also as schizophrenia, experts say. Psychosis by itself isn’t a disorder, explains Timothy B. Sullivan, MD, chair of Psychiatry and Behavioral Sciences at Staten Island University Hospital in Staten Island, New York. “It’s not an illness in itself, even as fever isn’t an illness,” he explains. “Psychosis is caused by impairment within the part of the brain that helps us discern what’s happening internally versus what’s happening externally.”
Psychosis is common, says Theresa Nguyen, LSCW, of psychological state America (MHA). “Some 3% of the population experiences it at some point,” she says. “Some brain changes make an individual see or hear things that aren’t there. and therefore, the longer the person experiences psychosis without getting treatment, the more she starts to become more convinced that the items she sees, hears, and believes are real.”
“While psychosis can appear as if schizophrenia, a private with schizophrenia will have delusions and hallucinations no matter whether or not they are depressed,” says Ms. Nguyen.
Psychotic depression symptoms
To be called a depressive disorder, consistent with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, major depression must be present along with delusions and/or hallucinations. If psychotic features are present, they need to be either mood-congruent (having to try to do with typical depressive themes like personal inadequacy, death, or deserved punishment) or non-mood-congruent (in other words, not involving the depressive themes). Typically, the psychotic symptoms have a depressive ‘theme,’ like delusions of guilt, poverty, or illness.
Typically, the person with depressive disorder exhibits a sad mood, with poor concentration and feelings of lack of self-worth and guilt, says Anil Malhotra, MD, vice-chair of research within the department of psychiatry at the Zucker School of drugs at Hofstra/Northwell in Hempstead, New York. “And there are the psychotic features,” he says. “The person hears or sees voices and things that aren’t real, which are hallucinations, and believes things that aren’t real, which are delusions.”
What’s important to keep in mind is that hallucinations are much less common than delusions in a person with depressive disorder, says Dr. Rothschild. “The delusions are quite common and are of a depressing, nihilistic nature,” he explains. “For instance, the person may say they’re dying of cancer, or that they lost all their money, or that they did something bad, like not pay their taxes. The interesting thing is that on the surface, these delusions might be true. They need an air of reality about them.”
One of the explanations that depressive disorder isn’t easily diagnosed, he says, is that folks with a depressive disorder often realize that their thoughts might not be “quite right” so that they keep them to themselves. Dr. Rothschild described one patient who was convinced that he was dying of prostatic adenocarcinoma. Multiple doctors had examined him and located his prostate to be healthy, but he refused to accept this news. Finally, it had been suggested that he have a consultation with Dr. Rothschild, who diagnosed him with depressive disorder. After treatment, the patient got better.
Risk factors for psychotic depression
One of the most important risk factors is childhood trauma, says Dr. Rothschild. “Early life trauma puts you in danger,” he says. “The loss of a parent before age 11, as an example, or any trauma like sexual or physical abuse puts you in danger. And if an individual with these risk factors gets depressed as an adult, they’re at a better risk for depressive disorder.”
Additionally, it’s more likely for people to develop the depressive disorder as they grow old. “Psychotic depression can occur in any age bracket, but it’s not uncommon for somebody with no prior psychiatric history to present with depressive disorder in their 60s, 70s, or 80s,” Dr. Rothschild says. “In older people, delusions of poverty or somatic delusions, for instance, believing one is affected by a fatal illness, are more likely to be present.”
How depressive disorder Differs from Schizophrenia?
“If the person has pure psychosis, without much depression, it’s more likely to be schizophrenia,” says Amit Anand, MD, professor, and Vice-Chair for Research in the middle for Behavioral Health at the Cleveland Clinic. “And with schizophrenia, depression is typically not predominant, and therefore the person has hallucinations and delusions that don’t get away. They even have decreased thinking, feelings, and motivation.”
Schizophrenia tends to form an appearance for the first time when the patient is in their late teens or early 20s, while individuals can have a depressive disorder at any age, Dr. Rothschild says. “Schizophrenia is more long-lasting and isn’t episodic,” he explains. “The delusions tend to be weirder, although we don’t make the diagnosis support the sort of delusion.”
Treatment for depressive disorder
There are two modalities of treatment for depressive disorder, Dr. Rothschild says. “The combination of an antidepressant with an antipsychotic is one, and electroshock (ECT) is that the other,” he says. “That may be a decision to form with the family, and it depends on things.”
In some older patients, ECT could also be utilized to avoid the side effects of medication. Sometimes a course of ECT is prescribed then the antidepressant and antipsychotic are taken afterward. Talk therapy is often helpful, too, he says, but only after the first-line treatment of medication or ECT has been started, Dr. Rothschild says.
The prognosis for recovering from depressive disorder is superb, Dr. Rothschild says. “As you’ll imagine, if you’ve got an episode of depressive disorder, it can cause tons of disruption in your life,” he says. “It depends on the person, but generally speaking, an individual who receives treatment for depressive disorder is often back to their normal self during a few months.”
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