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What is Psychotic Depression?

By Marlene Garcia
Updated May 17, 2024
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Psychotic depression refers to a condition marked by symptoms of clinical depression combined with hallucinations or delusions that conflict with reality. A person suffering from psychotic depression might see and hear things that do not exist and suffer from irrational fear and suspicion. In severe cases, people with this disorder may be unable to provide for their own care and be deemed dangerous.

Signs of psychotic depression may include neglecting personal hygiene, such as wearing the same clothes for days and not bathing. The patient might avoid others when suspicions take over his or her thoughts. Explosive fits of anger or agitation are other common signs of the disease, along with conversations that make no sense to others.

The patient commonly exhibits signs of major depression. Those suffering from chronic depression might feel down for an extended period of time and feel helpless or hopeless. They commonly do not receive any enjoyment from life and believe there is no solution to their problems. Symptoms of major depression also include changes in appetite and sleep patterns. People suffering from major depression often turn to alcohol or drugs in an attempt to self-medicate.

There is no definitive cause for major depression that leads to psychotic depression outside of medical conditions linked to the disease. Some experts believe a chemical imbalance in the brain contributes to the disease. Others point to heredity as a factor, and some psychologists believe the inability to cope with painful life events triggers the disorder. Some health professionals consider all three possibilities, or a combination of them, when making a diagnosis.

Psychosis can evolve from diseases like Alzheimer’s that cause confusion in patients. A brain tumor or disease of the brain is also capable of causing symptoms that mimic psychotic depression, as well as some prescription medications. Doctors might also see signs of psychotic behavior when an addict is withdrawing from drugs or alcohol.

Treatment for this disorder generally involves antidepressant and antipsychotic medication over a long period. If a brain tumor is causing the condition, it can sometimes be treated with surgery. When medication alone does not work, electroconvulsive therapy may be an option. Treatment is usually deemed critical because those suffering from psychotic depression present a high risk for suicide.

Psychotic depression might affect people with other mental disorders, such as schizophrenia and bipolar disease. It has also been seen in patients with certain personality disorders. Diagnosis is usually done through blood tests that reveal abnormal hormone or electrolyte levels and brain scans.

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Discussion Comments

By anon293412 — On Sep 25, 2012

My friend takes lazy to new heights. She refuses to cook for herself (makes pots, pans and dishes and dishes to wash). She eats Lean Cuisine with a quart of ice cream. She buys things and never even takes them out of their boxes, but fills her rooms with them, plus her old mail, newspapers, etc. She’s already been evicted once over this and has begun again.

She says she is a night person, but stays up half the night rummaging through things to find something she thinks she lost. She avoids daylight because she says it exacerbates her skin condition (she says they are allergies but won’t go to a doctor because it costs money and that she knows herself better than they do).

She bought a computer but refuses to learn how to use it because it might get a virus -- in a box? She uses the oven for heating her instant meals. Her new microwave is almost 10 years old and still in the box.

She bought some nice logs for her fireplace but they are still wrapped up because if she burns them they will make ashes. “You could get them up in a dustpan,” I said. Her answer, “No, then the dustpan will get dirty.”

She collects checks from her stockholder shares but lets them lie in the dresser drawer until they have run out of time and then she scurries around to make them viable again.

She lost her job of over 25 years for allowing something to happen which could have been prevented and then tried to falsify records. (The patient died). Her answer to me, “I had a bad backache that night and couldn’t sleep before work.”

We had a big argument a month or so ago when I asked her how she was going to continue to exist if she didn’t even try to get a new job and how long would her nest egg last to support her? ($46,000). She grew furious and said, “I have an income and don’t you dare tell me what to do, etc. etc. etc.” I hung up on her and didn’t speak to her until recently when she called and acted like nothing ever happened.

Last night, she called me ranting and raving about her hands bleeding when she washes out her clothes in the sink. I asked why didn’t she put the things in a washing machine? She blew up on me. “You would think my friend of over 30 years would know better than to tell me what to do” I retorted, “Hold it right there. Don’t go any further. Change the subject.” She did.

Then she went on to tell me she has been having more and more “meltdowns” lately and wants to let out a primal scream. She doesn’t want to live on earth but to become an orb and never have to deal with hormones and things again. She then said “They (?) think I’m crazy; I can show them crazy! I get so mad I could kill!”

This upset me but I told her “I am tired, I think I will go to bed now.” We said good night.

To tell you the truth, she is upsetting me greatly as she has been my friend for over 30 years. I’m at a loss to know what to do for her. My daughter advises me to keep away from her because these conversations are dragging me down. She monopolizes conversations, turning everything that’s said to remind her of something she did years ago, etc. I feel really sorry for her because she used to be a very sweet person. She is immaculate about her face: skin, make up, etc., but the rest of her has grown fat, dowdy, with no new clothes for years. She patches the old ones whenever the skin shows through. Should I keep away? I am sorely tempted to.

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