Major depression with psychotic features is a mental disorder in which a person has depression along with loss of touch with reality (psychosis).
Psychotic depression; Delusional depression
The cause is unknown. A family or personal history of depression or psychotic illness makes you more likely to develop this condition.
Psychosis is a loss of contact with reality. It usually includes:
The types of delusions and hallucinations are often related to your depressed feelings. For example, some people may hear voices criticizing them, or telling them that they don't deserve to live. The person may develop false beliefs about their body, such as believing that they have cancer.
Your health care provider will perform a physical exam and ask questions about your medical history and symptoms. Your answers and certain questionnaires can help your provider diagnose this condition and determine how severe it may be.
Blood and urine tests, and possibly a brain scan may be done to rule out other medical conditions with similar symptoms.
Psychotic depression requires immediate medical care and treatment.
Treatment usually involves antidepressant and antipsychotic medicine. You may only need antipsychotic medicine for a short period of time.
Electroconvulsive therapy can help treat depression with psychotic symptoms. However, medicine is usually tried first.
This is a serious condition. You will need immediate treatment and close monitoring by a provider.
You may need to take medicine for a long time to prevent the depression from coming back. Depression symptoms are more likely to return than psychotic symptoms.
The risk for suicide is much higher in people with depression with psychotic symptoms than in those without psychosis. You may need to stay in the hospital if you have thoughts of suicide. The safety of other people must also be considered.
If you are thinking about hurting yourself or others, call 911 or the local emergency number right away. Or, go to the hospital emergency room. DO NOT delay.
You can also call the National Suicide Prevention Lifeline at 1-800-273-8255 (1-800-273-TALK), where you can receive free and confidential support anytime day or night.
Contact your provider right away if:
American Psychiatric Association. Major depressive disorder. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013:160-168.
Fava M, Østergaard SD, Cassano P. Mood disorders: depressive disorders (major depressive disorder). In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 29.
Reviewed By: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.