Introduction to psychotic depression

 

Sometimes, patients with depression may have symptoms of depression and psychotic disorder at the same time. In this case, the patient may be suffering from psychotic depression.

Psychotic depression can be understood as a form of major depressive disorder, and many patients with major depressive disorder will have symptoms of psychosis, but even so, most similar cases are classified as depression, not as schizophrenia or psychosis.

If a patient has symptoms of depression and psychosis at the same time, how can we tell if the patient is depressed or is having psychosis?

First, timing is an important factor. Most patients with psychotic depression have depressive symptoms first, and only at a later stage do the symptoms of psychosis appear. In contrast, patients with psychotic disorder or schizophrenia usually have symptoms of psychotic disorder, such as hallucinations or delusions, at first. Most of them are troubled by the symptoms and develop mood symptoms afterwards.

Second, we can categorize by the type of psychotic symptoms. The symptoms of psychotic depression are mostly mood congruent, such as persecutory delusion, nihilistic delusion, and so on. In contrast, the symptoms of psychotic disorder in patients with psychotic depression are more diverse and may not necessarily correspond to mood.

Third, some patients with psychotic depression can also have their psychotic symptoms reduced after treatment with antidepressants. On the contrary, most of the depressive symptoms persist in patients with psychosis / schizophrenia after taking antidepressants.

How should psychotic depression be treated? Is it the same as the treatment for depression?

The treatment of psychotic depression is not quite the same as ordinary depression, as patients generally need to receive higher doses of antidepressants and the treatment duration is longer than that for ordinary depression.

In addition to antidepressants, patients also need to take antipsychotics to control symptoms of psychosis. In general, patients take lower doses of antipsychotics than schizophrenics.

However, many cases of psychotic depression also fall into the category of treatment resistant depression. In addition to antidepressants and antipsychotic medications, patients could be treated with other types of therapy, including rTMS, Esketamine, or ECT.