Psychotic Depression - What Is It?Psychotic Depression - What Is It?

Psychotic depression is severe depression with associated hallucinations and delusions. Unlike schizophrenia, patients with this disorder can function normally between episodes. Those who suffer with this disorder experience unreal or imagined beliefs and visions, which can lead to disturbing and fearful behavior.

Delusions are the most common symptoms associated with the disorder. Patients can convince themselves that they are dying or that their neighbor is spying on them. These imagined events will often become the point of focus of their paranoia. This coupled with the depression makes this disorder a formidable condition to overcome. These delusions come from a misinterpretation of events that plant the seed in the sufferers mind. A complete stranger could smile at them in passing and they will insist that this person is in love with them. Or conversely, if they receive what they see as a less than warm greeting from someone, they assume that the person they interacted with is out to get them. They then begin to build on the delusion until it becomes all encompassing.

Although some patients with psychotic depression have hallucinations, this is not as common as experiencing delusions. Many of the depression symptoms are the same as major depression but some are unique to psychotic depression. Increased daydreaming or an increase in the intensity of the daydream is common. Moving more quickly or moving significantly more slowly can signal that someone is having difficulty and an increased or decreased sex drive can accompany some of the other symptoms. Many of these symptoms alone do not indicate that someone suffers from this disorder, however when they begin to add up, then psychotic depression should be suspected.

There is some research that shows there's an abnormality in the hypothalamic pituitary adrenal axis. This portion of the pituitary gland appears to be overactive in those suffering from psychotic depression. Sleep abnormalities are usually seen in these patients and the incidence of this disorder seems to increase when the barometric pressure is low.

Current treatment combines standard antidepressants with atypical antidepressants. Results are mixed and the associated side affects make taking these medications less than ideal. Electroconvulsive therapy or "shock" therapy as it is more commonly known, combined with antidepressants is the recognized and standard treatment for psychotic depression. Transcranial magnetic therapy is being looked as an effective alternative to shock therapy which has to date, been portrayed in a negative way in Hollywood. Unlike ECT, TMS does not require anesthesia and doesn't seem to have the cognitive loss seen with ECT.

Psychotic depression is difficult for both the patient and their families. As research continues to explore different avenues for treating this disorder, there is hope for these patients and those around them. Being labeled "crazy", they often can't control their feelings or how they perceive things. Patience and understanding are key in helping the patient seek treatment that can help them begin to level out to where they can live a normal life. Many have to remain on medication and without it will revert to previous psychotic behavior. If you suspect you or a loved one is suffering from psychotic depression, you should seek the opinion of a professional so that you can be properly diagnosed and treatment can begin.
by Milt Smalley
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There's a lot more to depression than just feeling blue or down. If you recognize yourself in several of the depression symptoms, please visit
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