Psychotic Depression occurs when a person who is depressed goes on to develop psychotic symptoms
such as delusions, hallucinations and depressive stupor, where a person, although conscious,
becomes almost entirely unresponsive. I'm Dr Beth Colby, a psychiatrist in London.
People with severe depression have a depressed mood, loss of interest and enjoyment in activities
that they'd normally find enjoyable, and reduced energy leading to increased fatigability and
diminished activity, with marked tiredness after even slight effort. The individual usually shows
marked distress or agitation - where they are unable to relax and sit still, or are constantly
fidgeting - or retardation - where their thoughts or actions are slowed down. People may have a very
low self-esteem and feelings of uselessness or guilt, and suicide is a distinct danger,
particularly in severe cases. It is presumed that somatic syndrome will almost always be present.
For a diagnosis of severe depression, as well as having the symptoms I've already described,
individuals will have four of the following symptoms: reduced concentration and attention,
reduced self-esteem and self-confidence, ideas of guilt and unworthiness, bleak and pessimistic
views of the future, ideas or acts of self-harm or suicide, disturbed sleep, disturbed appetite - and
the depressive episode should usually last at least 2 weeks. Studies suggest that of those
who experience severe depression, 14.7 -18.5 % of these will go on to develop psychotic depression.
As we do not know enough about the condition, it is impossible to predict who will get this.
However, psychotic depression is more common as people get older. It is likely, though,
that a specific combination of genes - such as those responsible for causing depressive symptoms,
plus those responsible for causing psychotic symptoms - in combination with the environment,
are responsible for the condition. In psychotic depression, the delusions are usually mood
congruent - that is, the false beliefs reflect the depressed mood. These are usually negative,
involving ideas of sin, guilt, poverty, hopelessness, failure, and the individual
may believe that they've been responsible for a terrible crime or disasters, leading to increased
anxiety and possible increased psychomotor agitation. The hallucinations are usually auditory
or olfactory. The voices are usually defamatory or accusatory, and the olfactory hallucinations
include smells of rotting filth or decomposing flesh. Severe psychomotor retardation may
progress to depressive stupor, where, although the person is conscious, aware and alert,
they are motionless and virtually unresponsive to stimuli except for intense stimuli such as pain.
This is very uncommon now, though, due to modern treatments. A person may be so ill with psychotic
depression that they require treatment in hospital, usually for their safety or for
their health, including physical. Alternatively, they may be under the care of a Home Treatment
Team. The person will usually already be on antidepressant medication, and antipsychotic
medication will be commenced when the person experiences psychotic symptoms. This combination
of antidepressant medication and antipsychotic medication has been shown to be significantly
more effective than antidepressant medication, or indeed antipsychotic medication, on their own. ECT
is a safe and highly effective treatment for those people who do not respond to medication. This
includes those who have severe suicidal thoughts and also those who may be dehydrated due to
decreased oral intake. However, after the ECT treatment, to prevent a recurrence of symptoms,
a person will need to take ongoing treatment of antidepressants. Psychological therapies
may be used - although, when a person is very unwell, particularly with their concentration,
it may be initially difficult to engage in this. Patients of course will need social support
and close follow-up for monitoring of their condition. Thank you for listening. 'Bye for now.