Psychotic depression: what are the symptoms and treatment?

Taking care of mental health is necessary for the whole body to function well and for well-being in the routine. Therefore, understanding the different manifestations of mental illnesses and disorders helps to understand what happens in the body.

The depression psychotic major depression is a subtype. Although there are common symptoms, treatment may require specialized remedies and follow-up.

Who to know more about the subject, understand the symptoms and treatment? The Healthy Minute helps you

What is psychotic depression and what is the ICD?

There are different types of depression, so symptoms can vary. Psychotic depression is a subtype of the disease.

Psychotic depression is a subtype of major depression. It is characterized by feelings of deep sadness , lack of energy and self-deprecating thoughts, accompanied by psychotic symptoms such as delusions and hallucinations.

In the International Code of Diseases (ICD-10), it is found by code F33.3, with the description “Recurrent depressive disorder, current severe episode with psychotic symptoms”.

The psychosis can be defined as a loss of contact with reality, in which the person has difficulties in judgment. That is, he is unable to discern what is real from what is only the fruit of his own thoughts.

In general, depression already impairs contact with reality a little, however, it does not reach the level of loss of contact of psychosis.

Still, in extreme cases, the person may actually experience this loss, presenting psychotic symptoms such as delusions, paranoia and hallucinations.

Psychotic depression is different from other psychotic disorders, as symptoms such as delusions and hallucinations are directly related to the mood episode.

In short, a person with schizophrenia , for example, has psychotic symptoms regardless of how they are feeling, while a person with psychotic depression will only have them while in a depressive episode.

Psychotic symptoms can also arise in bipolar depression, but the diagnosis, in this case, is bipolar disorder , with different conditions.

Therefore, when visiting a psychiatrist, it is necessary to investigate whether the person has had episodes of mood that resemble episodes of mania or hypomania, avoiding confusion in the diagnosis.

What are the symptoms of psychotic depression?

Psychotic depression is characterized by symptoms of a major depressive episode, such as:

  • Sadness and / or depressed mood most of the day, almost every day;
  • Decreased interest or pleasure in almost all activities most of the day, almost every day;
  • Weight changes (loss or gain) without explanation;
  • Changes in appetite (more or less);
  • Changes in sleep pattern (insomnia or excessive sleep);
  • Psychomotor agitation or retardation (making movements more slowly);
  • Fatigue or loss of energy;
  • Feelings of worthlessness or guilt;
  • Concentration difficulties;
  • Indecision;
  • Recurring thoughts of death;
  • Suicidal ideation (willingness to commit suicide, planning the act, etc.).

However, in addition to depressive symptoms, in psychotic depression there may also be psychotic symptoms, such as delusions and hallucinations.

Delusions are thoughts outside the reality of which the person is convinced, and it is useless to try to prove the opposite. These delusions can have varied themes, such as:

  • Believing that you made a mistake and that your life will end as a result of this (delusion of ruin);
  • Believing that you will lose all your money, become poor and have debts (delusion of financial ruin);
  • Believing that the world is ending and has no salvation;
  • Believing that others can read your thinking;
  • Believing to be controlled by extraterrestrial beings;
  • Believe that you are being pursued by government agencies;
  • Believing that you are being haunted or possessed by a supernatural entity.

In short, delusions can have very different themes, and it can even be difficult to see the difference between a delusion and a normal person’s characteristic.

If she, for example, believes in supernatural entities and believes that she is being haunted, it can be difficult for outsiders to realize that it is a delusion, not a matter of faith.

However, in the case of a delusion, it is clear that the person is convinced that it is real. That is, she cannot think rationally. A person who simply believes could go to a religious temple and solve the problem, without letting it consume a lot of time in his life.

The delirious person, on the other hand, will devote a lot of time to this idea, and even with evidence that it’s not real (or that he got rid of it, in the case of a supernatural belief, for example), he doesn’t stop thinking about .

In addition, the person may present auditory and visual hallucinations, such as seeing things that do not exist or that are not actually there, hearing voices that give commands or say disparaging things, among others.

It is normal for a person with depression to have self-deprecating thoughts, such as feeling useless, incapable, among others. However, in the case of psychotic depression, the person may hallucinate with voices saying all these things, cursing and making the person even worse.

How long does psychotic depression last?

Major depressive episodes have a limited duration of up to 6 months. Since psychotic depression is a subtype of major depression, it is estimated that its duration is the same.

However, although depressive episodes are limited, they can also be recurrent. That is, a person can have several depressive episodes over the years.

Therefore, if it is not treated, depression (psychotic or not) can last for the rest of the individual’s life, alternating episodes of normal mood and depressive episodes.

Generally, those who have an episode of psychotic depression actually experience recurrent depressive episodes, often untreated. The first depressive episode is hardly ever accompanied by psychotic symptoms.

How to treat?

Psychotic depression has treatment, which depends on a professional evaluation.

The treatment of psychotic depression is done with psychotherapy and psychiatric medications.

There is no consensus on a protocol for drug treatment of psychotic depression, but most psychiatrists prescribe a combination of antidepressants and antipsychotics to combat symptoms.

Some not-so-severe depressions can be treated only with psychotherapy, however, the psychotic component may need medications to keep symptoms under control.

In more severe cases, the person may be life-threatening and require hospitalization.

Medicines: what are the options?

The choice of medication will be made based on a psychiatric assessment, considering the intensity, frequency and clinical history of each patient. Remembering that only specialist professionals can indicate the correct treatment.

However, some options that can be indicated are:

Antidepressants

  • Imipramine ;
  • Amitriptyline ;
  • Fluoxetine .

Antipsychotics

  • Haloperidol ;
  • Perfenazine;
  • Risperidone ;
  • Ziprasidone .

Psychotic depression and major depression: are there differences?

As a subtype of major depression, psychotic depression has the same characteristics as major depression, but with some more characteristics. In this case, psychotic symptoms.

A study by researchers at USP shows that people with psychotic depression have changes in some brain structures when compared to people with major depression without psychotic symptoms or people without a diagnosis of depression.

Through neuroimaging, researchers realized that, in patients with psychotic depression, there is a change in the volume of the isthmus of the cingulate gyrus, a region of the brain that is part of the limbic system, responsible for emotions.

This structure makes the connection between the limbic system and the brain structures responsible for the perception of external stimuli. This raises the hypothesis that psychotic depression is linked to distortions in perception caused by brain changes.

Therefore, it is estimated that psychotic depression has biological differences in relation to classic major depression. However, further studies are needed to reach a definitive conclusion.


Psychotic depression is a subtype of major depression. Although there are symptoms in common, it causes episodes of hallucinations.

But there are ways to treat the condition and have a healthy life physically and mentally. Want to know more about psychology and psychiatry? The Healthy Minute, together with expert professionals, helps!

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