{"id":6539,"date":"2016-04-20T09:20:37","date_gmt":"2016-04-20T06:20:37","guid":{"rendered":"http:\/\/seragpsych.com\/wordpress\/?p=6539"},"modified":"2016-04-20T09:20:37","modified_gmt":"2016-04-20T06:20:37","slug":"psychotic-depression","status":"publish","type":"post","link":"https:\/\/seragpsych.com\/wordpress\/psychotic-depression\/","title":{"rendered":"Psychotic depression"},"content":{"rendered":"

What is psychotic depression?<\/span><\/span><\/em><\/strong>
\nSome people who have severe clinical depression (sometimes called major depressive disorder) experience hallucinations and delusions. They are said to have psychotic depression.
\nPeople who have severe clinical depression are in a depressed mood most of the day, practically every day, and can lose interest in almost everything.
\nMental health professionals call this sort of depression \u2018unipolar\u2019 depression in contrast to \u2018bipolar disorder\u2019, when people experience both episodes of depression and episodes of mania.
\nOther symptoms of severe clinical depression include extreme tiredness, disturbed sleep patterns and changes in appetite. People feel worthless and guilty, they are unable to concentrate and are indecisive. Many people also become very anxious, pre-occupied, or overly concerned about their health. When people are severely clinically depressed, their daily life becomes extremely difficult.
\nThe delusions and hallucinations experienced by people with psychotic depression almost always reflect their deeply depressed mood. The delusions and hallucinations are very negative, self-critical, self-punishing and self-blaming, and can make people feel even more anxious.
\nPeople with psychotic depression may also experience \u2018psychomotor agitation\u2019 \u2013 an inability to relax or sit still. They may rock, fidget, or move their legs a lot, for example. Being acutely and severely anxious, often as a result of the symptoms of psychosis, contributes to the psychomotor disturbance.
\nUnipolar depression tends to be episodic, and studies have shown that the majority of people who have had a first episode of severe clinical depression will go on to have at least one more. After a second and third episode, the risk of relapse increases substantially.
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\nWho gets psychotic depression?<\/strong><\/em><\/span>
\nThe estimated numbers of people who are likely to experience severe clinical depression at some time in their lives vary between three and 11 people in every 100. Women are twice as likely than men to develop depression \u2013 so two-thirds of people who have severe clinical depression will be women.
\nNot everyone who has severe clinical depression will experience the symptoms of psychosis. An estimated 10 to 15 per cent of people diagnosed with severe unipolar depression will at some stage go on to develop the symptoms of psychosis.
\nResearchers do not know why some people do, and others don\u2019t develop hallucinations and delusions. They are therefore unable to predict which people who have unipolar depression will experience the symptoms of psychosis.
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\nDiagnosis<\/span><\/span><\/em><\/strong>
\nThe classification systems used by mental health professionals to make a diagnosis describe ‘psychotic depression’ as a sub-type of major depressive disorder.
\nDoctors therefore use the criteria for \u2018major depressive disorder\u2019 or ‘severe depressive episode’ with additional symptoms of hallucinations and delusions.
\nMental health professionals will make a diagnosis by asking in detail about the symptoms people may be experiencing. They will also find out about an individual\u2019s past experience of depression, and whether family members have ever experienced depression or psychotic depression.
\nIt may, however, be difficult to make a diagnosis. The symptoms of psychosis may be subtle, and people with depression may sometimes not report that they are experiencing hallucinations and delusions because they are embarrassed by them. There is a danger too of misdiagnosis \u2013 If people are experiencing psychomotor agitation, for example, their symptoms could be attributed to severe anxiety.
\nIt is important for mental health professionals to work out if people are experiencing the symptoms of psychosis as part of unipolar depression, or as part of bipolar disorder (see Bipolar disorder page). This is because there are different treatments for psychotic depression and bipolar disorder.
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\nWhat causes psychotic depression?<\/span><\/em><\/strong>
\nResearchers don\u2019t know why some people who have unipolar depression develop the symptoms of psychosis, but they think genes may have a part to play.
\nResearch studies have shown that unipolar depression, particularly severe depression, runs in families. People are much more likely to develop depression if they have a first degree relative (mother, father or sibling) who has experienced unipolar depression. Researchers have also found that people are more likely to develop depression if they have experienced adversity in childhood.
\nThey have identified genes that make people more likely to develop depression, and they have identified genes that play some sort of a role in the symptoms of psychosis. Some researchers think it may be that a person who inherits a combination of these genes may be more likely to develop psychotic depression. However, they do not yet understand how many genes are involved and how they interplay. One theory is that there is a set of genes that contribute to the development of psychosis, and some individual genes that determine whether people go on to develop bipolar disorder, schizophrenia or unipolar depression.
\nResearchers also think high levels of the stress hormone cortisol may be involved in some way. High cortisol levels are found in people with depression and people with other mental health problems.
\nSome researchers think that the content of hallucinations, particularly voices, experienced by people with psychotic depression may be associated with traumatic events in the recent or distant past.
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\nHow is psychotic depression treated?<\/strong><\/em><\/span>
\nPeople who have severe, clinical depression and experience hallucinations and delusions should be referred to a specialist mental health service. Some people may need hospital treatment: there are not many specialist units in the country, so this may be on a general psychiatric ward. Alternatively, they may be under the care of a community-based home treatment team.
\nThe treatment will initially concentrate on the depression, rather than the symptoms of psychosis. People will normally already be taking medication for severe depression \u2013 antidepressants, or a combination of drugs, which may include antidepressants, mood stabilisers and drugs that counter anxiety (anxiolytics). The National Institute for Health and Care Excellence (NICE) recommends that in addition to medication, psychological therapies should be part of a package of treatment for severe clinical depression.
\nWhen delusions and hallucinations develop, mental health professionals may also prescribe an antipsychotic drug. However, there hasn\u2019t been much research into what is the best combination of medication for psychotic depression.
\nThe NICE guidance on the treatment and management of depression in adults says mental health professionals should consider prescribing antipsychotic medication, though it also acknowledges there is not much evidence available about the best type or dose.
\nPsychotic depression is one of the few illnesses where ECT (electroconvulsive therapy) may still be used as a treatment. The NICE guidance on depression says ECT should be used to treat the symptoms of profound depression, not the symptoms of psychosis, and should only be used if urgent treatment is needed, or if other treatments have not helped the depression. ECT (when an electric current is passed through the brain) is always given in hospital, and under general anaesthetic. Health professionals should explain how ECT works, and the potential side effects \u2013 people may experience a loss of memory, for example. People have to give their consent before ECT is administered.
\nOther treatments for severe clinical depression are currently being developed and tested. These include rTMS \u2013 repetitive transcranial magnetic stimulation. This involves putting an electromagnet on the scalp to produce magnetic pulses that stimulate a small part of the brain to reduce its activity. People are conscious throughout the procedure and no anaesthetic is needed. NICE does not recommend rTMS for the treatment of depression because there is not yet sufficient evidence to prove it is effective.
\nOther researchers are trialling drugs that may reduce cortisol levels, and some studies are looking at the effectiveness of \u2018vagus nerve stimulation\u2019, where an electrode is placed in the brain to constantly stimulate and regulate electrical activity.<\/p>\n","protected":false},"excerpt":{"rendered":"

What is psychotic depression? Some people who have severe clinical depression (sometimes called major depressive disorder) experience hallucinations and delusions. They are said to have psychotic depression. People who have severe clinical depression are in a depressed mood most of the day, practically every day, and can lose interest in almost everything. Mental health professionals […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5,427,7,151],"tags":[],"class_list":["post-6539","post","type-post","status-publish","format-standard","hentry","category-5","category-427","category-7","category-151","entry"],"_links":{"self":[{"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/posts\/6539","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/comments?post=6539"}],"version-history":[{"count":1,"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/posts\/6539\/revisions"}],"predecessor-version":[{"id":6540,"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/posts\/6539\/revisions\/6540"}],"wp:attachment":[{"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/media?parent=6539"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/categories?post=6539"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/seragpsych.com\/wordpress\/wp-json\/wp\/v2\/tags?post=6539"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}