Psychotic depression is a debilitating form of major depression, complicated by psychotic symptoms including the following: 

• Hallucinations :  

• Paranoia : 

• Delusions : where the patient falsely yet strongly believes in an idea or concept, despite being surrounded  by facts

 

Other symptoms are shared with those of major depressive disorder e.g. 

• Observable intense depressive  symptoms 

• Severe impairment of daily functioning 

• Psychomotor agitation: e.g. unable to remain still, acute or severe anxiety is ofetn responsible for the psychomotor agitation 

 

Psychotic symptoms are ofetn a consequence of untreated major depression. Patients who suffer from major depressive illnesses, are more prone to psychotic symptoms, occurring in 20% of indiviuals . It is estimated that approximately 10-15% of majorly depressed individuals will develop psychosis, however researchers are unable to determine which indivduals (suffering from depression) will experience hallucinations or delusions. 

 

Diagnosis 

 

In order to diagnose psychotic depression, the patient must display psychotic symptoms consistent with mood congruent/congruent. Delusions are typically more common compared to hallucinations with a prevalence of 90% and 10%  respectively. Other diagnostic features such as guilt, distinct  psychomotor agitation e.g. fidgeting, restlessness, rocking back and forth. Impairment of cognitive function (progressing to pseudo dementia) is also another diagnostic feature. Psychotic depression is viewed as a subtype of major depression, consequently practitioners use the diagnosticciteria for major depressive disorder accompanied by hallucinations and delusions. Mental health professionals will thoroughly question patients regarding symptoms that they may be experiencing. Previous history of depression and whether the family have either suffered from either depression or psychotic epression must also be questioned about. Such questions include the following:

 

• Do you hear voices telling you to hurt/kill yourself or others?

• Do these voices tell you you're bad and/or should be punished?

• ​Is somebody spying on you?

• ​Do you fell like a good person, or do you feel guilty?

• ​Are you being punished for something that you have or feel that you have done?

 

 

Maudsley Prescribing Guidlines.

 

 

• According to the Maudlsey Prescribing Guidelines, combined treatment consisting of an antidepressant and antipsychotic is often  recommended as 1st line treatment, however it also states that the evidence behind this is not strong. 

• ​A combination of antidepressant and antipsychotic is deemed more efficacious compared to just an atipsychotic used alone, however whether this combination is more efficacious than just an antidepressant is undetermined.

• ​The long term implications for patients suffering from psychotic depression is poorer than those suffering from from non-pyschotic depression.

• ​Patients suffering from psychotic depression, may also show a poor response to combined pharmacological and non pharmacological  treatment compared to those with non-psychotic depression.   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

     

  What does NICE say?

  NICE recommends that the patients current treatment plan should be augmented with antipsychotic medication. However there's also             little evidence supporting the best dose or duration of treatment. ECT is also another method of treatment.