# Psychotic depression?



## phoebe22 (May 7, 2011)

The psych powers that be are now making noises about "psychotic depression with anxiety". This is scaring me because now I have visions of The Ward galloping around in my head. No one has explained to me what it is or why they think I've got it. Knowing why would be helpful (duh!) but my first concern is what I have to do to keep them from throwing me back onto the ward.

:yikes3:


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## David Baxter PhD (May 7, 2011)

As long as you are able to function on a day-to-day basis outside of hospital, "psychotic depression" doesn't need to mean forced hospitalization and, as I've said many times before, mental; health beds these days are soscarce that if you don't NEED to be in hospital they will make every effor to maintain you on an outpatient basis.

Tbhe label simply means that the predominant clinical picture is one of a mood disorder (depression) and anxiety but that there are some psychotic symptoms added into that pictuire, e.g., hallucinations or delusional thinking of some sort. In terms of treatment, the most likely outcome is that they would add one of the so-called "atypical antipsychotics" into the medication mix, or p[ossibly instead of any current medications. These would be medications like Seroquel, Zyprexa, or Abilify and the like.


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## phoebe22 (May 7, 2011)

David Baxter said:


> As long as you are able to function on a day-to-day basis outside of hospital, "psychotic depression" doesn't need to mean forced hospitalization and, as I've said many times before, mental; health beds these days are soscarce that if you don't NEED to be in hospital they will make every effor to maintain you on an outpatient basis.
> 
> Tbhe label simply means that the predominant clinical picture is one of a mood disorder (depression) and anxiety but that there are some psychotic symptoms added into that pictuire, e.g., hallucinations or delusional thinking of some sort. In terms of treatment, the most likely outcome is that they would add one of the so-called "atypical antipsychotics" into the medication mix, or p[ossibly instead of any current medications. These would be medications like Seroquel, Zyprexa, or Abilify and the like.



That explains a lot. First, I've been told that my health problems are "all in my head" from day one (except for the specialist who dx'd me in the first place) so that would be perceived as delusional (I think?)

I'm already taking low-dose seroquel for dissociation, so in terms of meds I don't know what they think they can add. Hopefully they won't push me on it.

I hope those beds are at as high a premium as you say; after my last couple of experiences, I don't think I'd emerge from another visit intact.

Thanks for the clarification.

BTW, this is probably a really stupid question, but can non-stop stress trigger a psychotic episode? This is the first time anyone's ever applied that label to me, and I'm just wondering if it may be due to several months of exceptionally high stress levels. I feel like I'm hanging on by a thread at best (but please don't tell them that ).

Phb


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## David Baxter PhD (May 7, 2011)

I would say it's possible, if it occurs on top of an existing anxiety disorder or PTSD, etc.


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## phoebe22 (May 7, 2011)

David Baxter said:


> I would say it's possible, if it occurs on top of an existing anxiety disorder or PTSD, etc.


 
I don't think they're removing the PTSD from my file ... just throwing more stuff at it and repeating the anxiety bit. Maybe one of these days having so many labels slapped on me will be funny? Well, even an antiquated old girl can hope ... 

Merci

Phb


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## Dragonfly (May 8, 2011)

phoebe22 said:


> BTW, this is probably a really stupid question, but can non-stop stress trigger a psychotic episode?


 
Phb - not a stupid question at all.  Not even close.  One way to think of "psychosis" is that there is impaired reality testing.  So, the bazillions of times of day we "test" our environment to know that it is real, the test fails.  Like - what is making that noise?  Like - not worrying about other people talking cuz you know that it has nothing to do with you.  Like - if you described what you see, everyone around you would see the same things.   In general terms, depression can get so bad that impaired reality testing or psychosis happens.  As Dr. B points out, it can also happen with really severe anxiety or ptsd  (think about flashbacks taken to the max).  When this happens, usually additional meds are needed - partly because the physiological mechanisms that produce the impaired reality testing is different from those thought to produce depression.  So while, in general, ssri's can be very effective for some with depression, they will virtually never help someone with psychosis.  the other reason that additional meds are needed are generally because of the anxiety around the experiences.  

Maybe you could work with your providers around the Seroquel.  Maybe a slightly higher dose now until the symptoms are under better control?  Maybe talk with what he/she would recommend, then see if they could negotiate with you to only take the higher dose when you are maxed out (actually, hopefully a couple of hours before you are maxed out, but you know what I mean).  In general, hospitals are used when the individual cant keep themselves safe, or meds need to be aggressively managed and the individual needs more monitoring than can be done in the community.

Finally, I am so sorry that you are having a hard time.  Please believe that things will get better - they will.


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## phoebe22 (May 8, 2011)

Dragonfly said:


> Phb - not a stupid question at all.  Not even close.  One way to think of "psychosis" is that there is impaired reality testing.  So, the bazillions of times of day we "test" our environment to know that it is real, the test fails.  Like - what is making that noise?  Like - not worrying about other people talking cuz you know that it has nothing to do with you.  Like - if you described what you see, everyone around you would see the same things.   In general terms, depression can get so bad that impaired reality testing or psychosis happens.  As Dr. B points out, it can also happen with really severe anxiety or ptsd  (think about flashbacks taken to the max).  When this happens, usually additional meds are needed - partly because the physiological mechanisms that produce the impaired reality testing is different from those thought to produce depression.  So while, in general, ssri's can be very effective for some with depression, they will virtually never help someone with psychosis.  the other reason that additional meds are needed are generally because of the anxiety around the experiences.
> 
> Maybe you could work with your providers around the Seroquel.  Maybe a slightly higher dose now until the symptoms are under better control?  Maybe talk with what he/she would recommend, then see if they could negotiate with you to only take the higher dose when you are maxed out (actually, hopefully a couple of hours before you are maxed out, but you know what I mean).  In general, hospitals are used when the individual cant keep themselves safe, or meds need to be aggressively managed and the individual needs more monitoring than can be done in the community.
> 
> Finally, I am so sorry that you are having a hard time.  Please believe that things will get better - they will.



Thank you for the analogy; it's very helpful.

I've been thinking in terms of discussing the Seroquel dosage before they impose and attempt to enforce an increase. I'm very willing to try a short-term increase, but am concerned about developing an intolerance. I've been given several anti-psychotics and they were really bad news, especially for my heart/BP. I don't want to see Seroquel ending up in that or some other impossible category. It's a blessing when the stress/worry/anxiety become overwhelming or I feel I'm at risk of disconnecting (my term for what's been loosely identified as DDNOS); it would be very not-good to lose tolerance to that lifeline.

I hope I don't end up in another battle over anti-depressants. I was force-fed nearly every A/D on the market over the course of about 10 years, and am dangerously intolerant to all of them. This is due, I believe, to the neuro/metabolic mess created by my physical health issues (ME and FM do a lot of really weird things to brain chemistry and assorted vital functions) but since as far as the drs and shrinks are concerned, it's in fact all somatoform (sp?) ... though some "accept" the "possibility" of FM ... they tend not to believe me until I stop breathing or go into seizure in front of them.

It gets scary.

Many thanks,

Phoebe


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