Imagine that there is a person who wakes up every day stuck between feeling sad and imaginary thoughts and hallucinations. This is exactly the patient with psychotic depression who sees himself trapped between sorrows and delusions. Therefore, he deserves urgent medical assistance and continuous psychological support from those around him until he comes out of that state safely. Through this article, we will learn together about the causes and symptoms of this disease, along with methods of diagnosis and effective treatment.

What is psychotic depression?

Psychotic depression is one of the severe types of depression and is characterized by the patient suffering from symptoms of psychosis such as hallucinations and delusions, in addition to the known symptoms of depression, such as sadness and loss of interest. The patient is usually disconnected from reality, which puts him in a dangerous condition that requires comprehensive psychological treatment to get rid of the symptoms of both psychosis and depression together.

Causes of the emergence of psychotic depression

The causes of the emergence of psychotic depression are not the result of the moment, but rather are the result of a complex interaction between several factors, including environmental, psychological, and biological, and can be detailed as follows:

• التاريخ العائلي:
  Depression or any psychological disorder may be an inherited disease in the family, making the person vulnerable to infection.
• Disturbances in brain functions:
  There are some areas in the brain, such as the frontal lobe, that may function abnormally, causing this disorder.
• Imbalance in brain chemistry:
  A deficiency of neurotransmitters such as dopamine and serotonin may occur, causing symptoms of depression with psychosis.
• Exposure to repeated psychological trauma:
  Continuous exposure to psychological trauma and stress may lead to a state of psychological collapse for the person and turn into psychotic depression.
• Exposure to social isolation:
  A person may be exposed to social isolation for long periods, which turns into a feeling of loneliness and then a serious illness that leads to this type of disorder.
• Drug or alcohol abuse:
  Certain drugs, such as cocaine, crystal meth, or shabu, may trigger symptoms of psychosis, especially in people with a genetic predisposition to depression. 
• التغيرات الهرمونية:
  As happens with thyroid disorders, it may be one of the factors that affect the psychological and mood aspects of the patient, which increases the chances of infection.

Symptoms of psychotic depression

Symptoms of psychotic depression are divided into three categories, including physical, psychological, and behavioral symptoms, which we learn about in detail below:

Physical symptoms

Physical symptoms of the disease include:

• Changes in appetite, either loss or overeating, which affects the patient’s physical health.
• Changes in body language and even facial expression, making the person appear devoid of emotions.
• Sleep disorders, either insomnia or excessive sleep, which causes severe psychological changes.
• Constant, unexplained body pain such as headache, stomach and muscle pain.
• Lack of movement and speech until the patient reaches immobility.
• Fatigue and exhaustion with a feeling of stress when doing any activity.

Psychological symptoms

Psychological symptoms are among the most dangerous symptoms that parents notice about the patient, as they play an essential role in diagnosing the disease, and they include:

• Hallucinations mean hearing voices or seeing unreal things, speaking and interacting with them.
• Delusions are irrational beliefs, such as someone who believes that he is in a major disaster and it is imaginary.
• Bad psychological mood and deep sadness for no reason and does not improve with time.
• Constant feelings of guilt, self-flagellation, and internal beliefs that he is worthless.
• Confusion with poor concentration and inability to make any decision.
• Suicidal thoughts and the desire to die in advanced cases. 

Behavioral symptoms

As for the behavioral symptoms of psychotic depression, they include the following:

• Withdrawal, social isolation, and avoidance of family gatherings, with an unwillingness to interact.
• Neglecting personal hygiene and general appearance, and appearing in very poor condition.
• Stop doing any daily activities such as studying or work.
• Strange behaviors, such as talking to someone who is not there.
• He sometimes acts aggressively with those around him for no reason.
• Attempting suicide or self-harm due to depression. 

اطلع على Signs of depression to watch out for

Methods of diagnosing psychotic depression

Psychotic depression is diagnosed through many medical methods under the supervision of doctors and psychologists, the most important of which are:

• الفحص السريري: It is an interview with a psychiatrist to evaluate the patient's mood, the progress of psychotic symptoms, and his daily performance.
• Patient's medical history: The doctor asks the parents about any family history of depression, and also asks about the patient’s health condition, whether or not he suffers from any chronic diseases, in order to assess the general health condition.
• Use approved diagnostic criteria: Doctors rely on the DSM-5 to confirm that depressive symptoms have persisted for more than two weeks, and to confirm the presence of psychotic symptoms consistent with depression.
• Medical examinations: Which helps rule out any organic disease causing depression. Tests include a blood test to detect any hormonal disorder, brain imaging, and toxins testing to rule out the effect of medications or drugs on the brain. 
• Questionnaires and psychological assessment tools: The specialist doctor uses some standardized psychological tests to diagnose the condition, such as the Beck Depression Inventory (BDI) and the Psychotic Symptoms Assessment Scale (PANSS), which are approved and internationally recognized tests.

Book your consultation now at Rafah Psychiatry Centre At Al Mousa Specialist Hospital The center relies on the latest methods and techniques for diagnosing psychotic depression and other psychological disorders. Upon admission, the patient is subjected to many approved examinations and tests, in addition to psychological sessions that help him air his complaint safely.

How to treat psychotic depression

Treatment for psychotic depression depends on a variety of options that are mixed together, including drug therapy, psychotherapy, and some behavioral interventions to improve lifestyle. We get to know each of them in detail below:

العلاج الدوائي

Of course, drug treatment is the mainstay in the treatment of psychotic depression, and it includes an approved drug protocol under the supervision of a specialized doctor. No medication should be taken without a doctor’s recommendation, and medications include the following:

• مضادات الاكتئاب:
  Used to improve the patient's mood, such as selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs).
• Antipsychotics:
  They are used to control hallucinations and delusions and include atypical antipsychotics, such as Risperdal, and traditional antipsychotics, such as Haloperidol or Haldol.
• Auxiliary medications:
  Sometimes the doctor recommends anti-anxiety medications or tranquilizers, in addition to medications to treat insomnia and regulate sleep, which are auxiliary medications that can be dispensed with in some cases.

Psychotherapy sessions

Psychotherapy sessions are mainly used with medications to improve the patient's thoughts and feelings, and include the following:

1. العلاج السلوكي المعرفي CBT:
   These sessions help correct the negative thoughts and concepts that result from depression. They also work to deal with delusions and hallucinations in an organized and logical manner, and teach the patient the ability to deal with psychological pressures and confront them with courage.
2. العلاج الأسري:
   It is also called family education. These courses help families deal with a patient with psychotic depression and understand the disease, which encourages bonding and proper communication with the patient, thus reducing family pressures and problems.
3. Support groups:
   It includes a group session with depressed patients, where each of them talks about his experience and his journey to recovery, which strengthens the patient’s resolve and encourages him to complete treatment.

Behavioral therapy and lifestyle change

Behavioral therapy aims to encourage the patient to adhere to drug and psychological treatment in accordance with the doctor’s instructions, and to motivate him to make a comprehensive change in his lifestyle, which includes following a healthy diet, ensuring regular exercise, returning to previous hobbies, regulating daily sleep hours, and encouraging meetings with family and friends. 

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Complications of psychotic depression

The complications of psychotic depression may be painful and severe because it is in itself one of the most dangerous types of depression, so its treatment cannot be overlooked or neglected. In case of neglect, the patient will be exposed to these complications: 

• Loss of appetite and malnutrition, which puts the patient in a very poor physical condition that affects his general health.
• Isolation and deterioration of social relationships due to delusions and hallucinations that make the patient hostile to everyone.
• Chronic sleep disorders cause the patient to experience either severe insomnia or excessive sleep, which further deteriorates the condition.
• The risk of developing some behavioral disorders such as alcohol and drug addiction, or psychological disorders such as schizophrenia.
• Thinking about suicide is one of the most dangerous complications of psychotic depression, as it listens to internal thoughts and delusions that make him feel that he is worthless and that he must get rid of that life. 

Immediately contact the Rafah Center for Psychological and Rehabilitation Treatment affiliated with Al Mousa Specialist Hospital and begin treating psychotic depression and do not leave yourself or someone you have trapped in these dangerous thoughts and fears. There is an integrated medical team that works day and night to serve patients and provide the best medical care and psychological support at the hands of the best doctors and specialists in the Arab world.

Frequently asked questions

By answering the common questions we receive from our followers, we will learn more about psychotic depression:

Does depression lead to psychosis?

Yes, in some cases depression may lead to psychosis, especially in severe cases that were not treated properly, in addition to people with a family history of some psychological disorders.

Does a psychotic patient return to normal?

Yes, a psychotic patient may return to normal if he receives proper treatment in a timely manner without delay, and with appropriate psychological support, he may emerge from this ordeal, but the matter may take a little longer.

Can psychotic depression be cured?

Yes, psychotic depression can be cured or largely controlled with appropriate drug and behavioral treatment, and early intervention is the most important factor in recovery, but if the condition develops and treatment is neglected, it may be difficult to recover from the disease.

Medical references 

Psychotic Depression – webmd

Major Depression with Psychotic Features – healthline