# Major depression with psychotic features



## David Baxter PhD (Dec 14, 2008)

Major depression with psychotic features
_Modern Medicine_
Feb 6, 2008

Major depression with psychotic features is a condition in which a person experiences depression along with reduced contact with reality (psychosis). This can take the form of false beliefs (delusions) or seeing or hearing something that isn't really there (hallucination).

See also:


Major depression
Psychosis
*Alternative Names*
Psychotic depression; Delusional depression

*Causes*
Although there are no obvious risk factors, a family history of depression or psychotic illness increases the chances of developing this condition.

*Symptoms*
This condition occurs when a depressed person loses touch with reality and hallucinates or has delusions. The symptoms of psychotic depression are a combination of symptoms of depression and psychosis.

The content of the delusions and hallucinations can be consistent with depression. For example, some people hear voices criticizing them, telling them that they are not good enough or evil, or telling them that they don't deserve to live and should kill themselves. Psychotic depression requires immediate medical attention to prevent self-harm or harm to others.

*Exams and Tests*
Diagnosis involves:


Psychiatric evaluation
Physical examination
Laboratory tests
The health care provider should rule out other medical conditions that can cause the same symptoms (such as reactions to certain drugs).

*Treatment*
Treatment usually involves antidepressant and antipsychotic medication. Patients sometimes take antipsychotics briefly. Electroconvulsive therapy is very effective for this condition, but it is generally used after medication.

*Outlook (Prognosis)*
Having psychotic symptoms with depression is a serious condition. The depressive symptoms have a higher chance of returning than the psychotic symptoms. You may need to take medication for a long time to prevent depression from returning.

Ongoing treatment and monitoring offer the best chance of recovery and continuing to do well.

*Possible Complications*
Suicide or other self-harm is the most serious complication. You may need to stay in the hospital if you have thoughts of suicide. The safety of others must also be considered.

*When to Contact a Medical Professional*
Call your health care provider if you or someone you know experiences depression or psychosis.

*References*
International early psychosis association writing group. International clinical practice guidelines for early psychosis. _Br J Psychiatry_, 2005;187:s120-s124.


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## Jazzey (Dec 14, 2008)

If you were suffering from this condition, would you know the following for sure?



> This condition occurs when a depressed person loses touch with reality and hallucinates or has delusions.



Does the person suffering from hallucinations or delusions know that they are?  Or, would it be easy to convince yourself that it's just a symptom of something else? (like fatigue for instance).


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## David Baxter PhD (Dec 14, 2008)

I think it would depend on the severity of the condition.


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## NicNak (Dec 14, 2008)

I was curious of that too Jazzey.

I have chronic depression and I hear voices and see shadows a fair bit.  I know the voices are not real, but I wonder if this artical is talking about the same thing too.


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## Jazzey (Dec 14, 2008)

Thank  you - I think it's an interesting question because I think that human nature is to naturally dismiss what doesn't appear normal or natural to us.  I guess that would be a fear of mine - that I wouldn't recognize the symptoms if I had them. It would be all too easy for me to find another reason for them...

*Jazzey added 34 Minutes and 13 Seconds later...*

..Just read another post where you (Dr. Baxter) had already stated that if the person is cognizant of the fact that their thinking is irrational, then it's not psychosis - I think that answers my question (again, contingent on the degree and severity of the illness).


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## David Baxter PhD (Dec 15, 2008)

Even individuals with emerging schizophrenia are often cognizant of the fact that their thinking and hallucinations are "not right", so they do their best to hide the symptoms from others. I used to tell my students that the key is to keep them taling long enough where the effor it takes to hide the symptoms becomes tiring and/or they'll relax enough to let you know what they're hearing or seeing.


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## NicNak (Dec 15, 2008)

I always make sure my doctors both know any new symptoms I have.  I hear the voice, but don't see images of the person talking.  The shadows don't have any defineable shape.  My doctor always asks to make sure the voice doesn't give directions and make sure I know it isn't real.

Usually I just hear them call my name or say hello or hi.  

But like I said before, both my doctors know, so no need for anyone to worry 

I only once had an actual identifyable halucination where I was with my mom and I thought a dog ran infront of me, but there was nothing there.  But I had just started a new strong medication.


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## Jazzey (Dec 15, 2008)

Thanks Dr. Baxter.  I guess the trick is to talk to your T if you think you're having any of these symptoms- as NicNak suggested.


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## ladylore (Dec 15, 2008)

> Usually I just hear them call my name or say hello or hi.



This has happened to me since I was a kid. The calling my name part, but not saying hello. Almost every time I run water or put the earphones on to listen music I hear my name being called.


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## Jazzey (Dec 15, 2008)

When I get very depressed, I usually start believing that everyone dislikes me - and can go pretty far with the thought.  That's what prompted my initial question...But I don't know how much of it is my own internal dialect handing me on a silver platter all the reasons why people would dislike me?


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## NicNak (Dec 15, 2008)

I have never seen any reason why anyone would dislike you Jazzey :hug:, or Ladylore :hug: , or Dr Baxter :hug:

I think when we get into a big downer depression that is when all the self doubt comes in.  We feel horrible and have a feeling of dread and negativity, so the self doubts just come along with that.

I feel sometimes that people are "out to get me" or they don't like me too.  But I have pretty strong relationships, so I seem to get past that pretty quick, at least that aspect of it.


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## Jazzey (Dec 15, 2008)

****Admin ****

My New posts tell me that NicNak has added to the thread...but I'm not seeing her post when I come here?

*Jazzey added 0 Minutes and 43 Seconds later...*

....darn...now I see it - Please delete....:red:

*Jazzey added 2 Minutes and 30 Seconds later...*

Thanks NicNak - I don't feel that way most of the time...just when I'm feeling really low.  Thankfully, that doesn't happen too often! 

But thank you for your kind words NicNak:hug:

*Jazzey added 117 Minutes and 22 Seconds later...*



> Thanks NicNak - I don't feel that way most of the time...just when I'm feeling really low. Thankfully, that doesn't happen too often!
> 
> But thank you for your kind words NicNak



Here's what I wrote a little while ago...And now, a few questions.

I'm looking for a little insight.  I've now gone and ready numerous threads on psychosis and on schizophrenia here on the forum.

A few questions flow from those readings:

Is it possible to only discover, much later in life, that you suffer from a type of psychosis and/or a type of schizophrenia?

How would you not have noticed earlier?

Would your psychologist recognize the symptoms and disclose that kind of diagnosis? 

...All right, I've deleted and written this post a few times.  I'm going to cross my fingers and just post the darn thing.

It's difficult to post this one only because I don't want to sound like a hypochondriac on such a difficult topic.  I've been a little stressed lately and sometimes wonder whether I'm losing my insight.  During my working hours, I don't seem to find it difficult to be rational.  

...Maybe, where I'm concerned, I need to stop reading so much into my "readings".


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## David Baxter PhD (Dec 15, 2008)

Jazzey said:


> I'm looking for a little insight.  I've now gone and ready numerous threads on psychosis and on schizophrenia here on the forum.
> 
> A few questions flow from those readings:
> 
> ...



The short answer is that, while schizophrenia typically shows up first (i.e., the first psychotic episode) between about age 18 and age 25 or so, it can also develop later in some cases. But there is always a pattern of eccentric or dysfunctional thinking and behavior before that, usually in evidence in childhood or adolescence - close friends or family members will generally describe the individual as "a little different".

You would have noticed certain things yourself, differences in your thinking and perceptions, although it's quite possible that you may have attributed those differences or unusual characteristics to something other than mental illness.

Until the first psychotic episode, it isn't always clear that the individual is indeed suffering from schizophrenia or some other disorder. However, any competent psychologist or psychiatrist should be able to see certain signs and symptoms that are suggestive. Differential diagnosis is most difficult if the individual is using street drugs, which is often the case with developing schizophrenia.


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## Jazzey (Dec 15, 2008)

Thank you Dr. Baxter....I don't know.  Opportunity to use this guy again  - :construction: 



> Differential diagnosis is most difficult if the individual is using street drugs, which is often the case with developing schizophrenia.



If alcohol is included - that's been my only indulgence.  However, my T is aware and I've pretty much cut this one out of my life. 

Thanks again,


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## NicNak (Dec 15, 2008)

David Baxter said:


> You would have noticed certain things yourself, differences in your thinking and perceptions, although it's quite possible that you may have attributed those differences or unusual characteristics to something other than mental illness.



I think can relate to this.  Things I seemed to have understood before, don't make sense anymore.  I don't understand a lot of peoples ways of thinking and priorities, although I don't argue about it.  I just listen and wonder why I don't think that way and other people do. It feels almost like peices of myself are missing, but I view them as negative traits anyway, so I guess that is why I am not concerned, maybe I should be?  I see things in other people and when I try to think of what that "odd" quality is, I get blocks almost in my brain about what it is and what it's purpose is.   I don't know where the little bits of this went that I had, but it is not here anymore.

I have noticed in the past few years a drop on my "compasity".  I try to keep myself challenged with small tasks so I at least feel a sense of accomplishment and not failure.  Not sure if this is simular to what Dr Baxter said.   I don't feel afraid about it for some reason.  People at work seemed more concerned about my drop in mental compasity than I was.  Most people who know me, know the core of my morals has not changed, but I am different and they just except that now.



David Baxter said:


> Until the first psychotic episode, it isn't always clear that the individual is indeed suffering from schizophrenia or some other disorder. However, any competent psychologist or psychiatrist should be able to see certain signs and symptoms that are suggestive. Differential diagnosis is most difficult if the individual is using street drugs, which is often the case with developing schizophrenia.



My Psychiatrist says about my "episodes".  Or will ask if I have had another "episode", he doesn't call these panic attacks.....I am not afraid cause I know he and my Family Doctor have a solid understanding of me and I trust them very much.

See, I never asked my Psychiatrist what is actually wrong with me, until I had to for work and he replied "You just tell them you have chronic depression and panic attacks.  Don't get into symptoms as those are very private and you should never feel obligated to discuss those.  The symptoms are between me, your family doctor and anyone else you CHOOSE to share them with"

I wonder if he thinks the title of the diagnosis will scare me and doesn't tell me as he sees I am content?  I don't know, but I don't feel the need to worry.

I tried marijuna once before, but no other drugs.  I smoke cigarettes.  I don't drink anymore, did socially but no longer since for 6 years now.


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