Medicines for Psychotic depression

What it is

Psychotic depression (depression with psychosis) is a severe form of depression in which a person, along with the symptoms of depression, also experiences psychosis — losing some contact with reality, in the form of delusions (strongly held false beliefs) and/or hallucinations (perceiving things that are not there, such as hearing voices). It is a serious mental health condition. The depressive part of the illness involves the features of a severe depression — such as a persistent low mood, loss of interest and pleasure, feelings of worthlessness or excessive guilt, hopelessness, loss of energy, changes in sleep and appetite, difficulty concentrating, and, importantly, thoughts of death or suicide. In psychotic depression, the psychosis is typically in keeping with the depressed mood (mood-congruent) — for example, delusions involving themes of guilt, worthlessness, illness, poverty, or a belief that something terrible has happened or will happen, and hallucinations (such as hearing voices) with negative or critical content. The combination of severe depression and psychosis makes it a particularly serious form of depression, with a higher risk, including of suicide, so it needs prompt, appropriate treatment and support, usually with specialist mental health input. Because the person may not recognise that their beliefs or perceptions are part of an illness, and because the condition is serious, it is important that it is recognised and treated, and that the person is supported and kept safe. The important and hopeful point is that psychotic depression is treatable, and people can recover with appropriate treatment: treatment usually involves a combination of medication (antidepressants together with antipsychotic medicines) and, in some cases, other treatments, along with psychological support and support for the person and family, provided by specialist mental health services; in severe cases, treatment may be given in hospital to keep the person safe and provide intensive care. With treatment, the psychosis and depression can improve, and people can recover. The key messages are that psychotic depression is a severe form of depression with psychosis (delusions or hallucinations), that it is serious and carries a higher risk, and that it is treatable with prompt specialist mental health care, with which people can recover.

How it is treated

Psychotic depression is a serious condition needing prompt specialist mental health care, and is treated with a combination of medication and support, with which people can recover; keeping the person safe is a priority given the higher risk. Because psychotic depression is severe and carries a higher risk (including of suicide), and because the person may not recognise their symptoms as part of an illness, it is important that it is recognised and that help is sought promptly — through a GP, mental health services, or, in a crisis or emergency, urgent and emergency services. Assessment is by mental health professionals, who assess the depression and the psychosis, consider the diagnosis, and, importantly, assess and manage risk (including the risk of suicide), keeping the person safe. Treatment usually involves specialist mental health care and a combination of approaches: medication is central — usually a combination of an antidepressant and an antipsychotic medicine, which together treat both the depression and the psychosis and are more effective than either alone for this condition; in some cases, particularly severe, life-threatening, or treatment-resistant cases, another treatment called electroconvulsive therapy (ECT) may be considered and can be effective for severe psychotic depression, given under specialist care. Psychological support and, as the person recovers, talking therapies also have a role, along with support for the person and their family. Because of the seriousness and higher risk, treatment is often provided with close support, and, in severe cases, may involve admission to hospital to keep the person safe and provide intensive treatment and monitoring, particularly if there is a significant risk to the person or they are unable to care for themselves. Support and monitoring continue as the person recovers, with treatment to help maintain recovery and prevent relapse, and support for the person and family. It is very important to seek urgent help if there are thoughts of suicide or self-harm, or if the person is at risk or in crisis. The reassuring and hopeful messages are that psychotic depression, although a serious and higher-risk condition, is treatable — usually with a combination of antidepressant and antipsychotic medication (and, in some cases, ECT), along with support — that people can recover with appropriate specialist treatment, and that keeping the person safe and providing prompt care are priorities; so recognising the condition, seeking prompt help (urgently in a crisis), and specialist mental health treatment are the keys to managing psychotic depression.