Psychotic Depression Explained

Medically Reviewed By Yalda Safai, MD, MPH
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Psychotic depression is a combination of the symptoms of major depression and psychosis. It is also known as major depression with psychotic features. Major depression is a mental disorder that causes persistent, unexplained feelings of sadness and hopelessness. It can affect a person’s daily routine and quality of life.

Psychosis, however, causes a person to feel like they are losing touch with reality. It triggers episodes of hallucinations and delusions.

This article will define psychotic depression. It will also explain the symptoms, causes, and treatments for the condition.

What is psychotic depression?

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Lyuba Burakova/Stocksy United

Psychotic depression is a type of major depression that may distort a person’s perception of reality. It essentially causes a person to have:

  • delusions, which are false beliefs, especially negative ones
  • hallucinations, which involve seeing or hearing things that are not there
  • both of the above, alongside symptoms of depression

In some cases, the condition may also cause catatonia or melancholic depression.

Catatonia is a mental state in which a person cannot speak or move. Melancholic depression refers to intense feelings of sadness and hopelessness.

According to sources, psychotic depression is an under-recognized and underdiagnosed condition.

Other names for psychotic depression include: 

  • depression with psychotic features
  • major depressive disorder with psychotic features
  • psychotic major depression
  • depression with symptoms of psychosis

Read more about depression and the different types of depression.

Psychotic depression vs. non-psychotic depression

A person with non-psychotic depression will experience a depressive mood but without psychotic symptoms. A person with psychotic depression will go on to develop delusions and hallucinations along with their depression.

A 2021 study found that psychotic depression causes more severe functional impairment than non-psychotic depression. The study also indicates that psychotic depression has a different treatment response than non-psychotic depression.

Psychotic depression vs. schizophrenia

Psychotic depression and schizophrenia can have similar symptoms, but differ in important ways.

Schizophrenia causes a person’s thoughts, feelings, and behavior to change. It also causes psychosis and depression, although these symptoms do not always occur together.

Psychotic depression, on the other hand, causes a person to experience symptoms of psychosis during depressive episodes.

Read more about schizophrenia.

What are symptoms of psychotic depression?

A person experiencing psychotic depression will have symptoms of both severe depression and psychosis.

Symptoms of severe depression include:

  • extreme sadness 
  • fatigue
  • changes in appetite
  • concentration and decision-making problems
  • hopelessness
  • feelings of worthlessness, failure, or guilt
  • loss of interest
  • disturbed sleep

Symptoms of psychosis include:

  • delusions
  • hallucinations
  • psychomotor agitation, which is a severe state of restlessness
  • incoherent or nonsense speech
  • social withdrawal
  • other eccentric behaviors

According to the National Health Service (NHS), people with psychotic depression often have an increased risk of suicidal thoughts.

Suicide prevention

If someone you know is at immediate risk of harming themselves or others, or at risk of suicide:

  • Ask the question, “Are you considering suicide?” even if it is tough.
  • Listen without judgment.
  • Call 911 or your local emergency number.
  • Stay with them until emergency services arrive.
  • Try to remove any weapons, medications, or other potentially harmful items.

If you or someone you know is having suicidal thoughts, contact the Suicide & Crisis Lifeline:

  • Call 988
  • Chat with the lifeline

This service is available 24-7.

What causes psychotic depression?

Research is uncertain about what causes psychotic depression. It may be a combination of genetic and environmental factors.

Genetics may be part of the cause of psychotic depression because the condition can run in families. Environmental factors may also play a role because childhood trauma and other distressing events can sometimes trigger the condition.

Research is ongoing to more fully understand the causes of psychotic depression.

How do you treat psychotic depression?

Treatment for psychotic depression focuses on managing symptoms and improving quality of life.


Psychological therapies such as cognitive behavioral therapy (CBT) can help you develop coping skills. You can receive CBT in individual sessions or with family.

Other types of therapies include:

  • behavioral activation
  • acceptance-based depression and psychosis therapy
  • acceptance and commitment therapy


Certain medications may help to ease the symptoms of psychosis and depression. These can include antipsychotics such as olanzapine and quetiapine and antidepressants such as SSRIs.

Electroconvulsive therapy (ECT)

ECT involves passing an electric current through the brain to provide stimulation. It is highly effective but can carry a risk of side effects such as headaches and nausea. Doctors typically only consider this treatment if antidepressants and antipsychotics do not improve symptoms.

If you have persistent symptoms of psychotic depression, your doctor may suggest you spend time in a psychiatric facility. They may then recommend follow-up appointments to monitor your condition.

What are risk factors for psychotic depression?

A variety of factors may increase your risk of psychotic depression. They include:

  • being assigned female at birth
  • being of older age
  • being unemployed
  • living alone
  • childhood adversity, including neglect
  • having no close friends
  • having little or no contact with family
  • family history of a mental disorder
  • family history of psychosis
  • traumatizing life events

How can you prevent psychotic depression?

Psychotic depression may not be preventable. However, treatments are available. It is important to follow any treatment plan your doctor recommends if you have this condition.


Psychotic depression is major depression and psychosis occurring together. Symptoms include hopelessness, feelings of worthlessness, and disturbed sleep. Other symptoms include delusions, hallucinations, and incoherent speech.

It is uncertain what causes the condition. However, it may be a combination of genetic and environmental factors. These factors include a family history of mental disorders, a lack of close friends, and childhood adversity.

Treatment options are available to help manage symptoms of psychotic depression. They include antidepressants, antipsychotics, and psychological therapies.

Seek medical advice if you experience symptoms of psychotic depression.

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Medical Reviewer: Yalda Safai, MD, MPH
Last Review Date: 2022 Sep 26
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