Psychotic depression is a psychiatric unit in which the patient exhibits both depressive symptoms and psychotic symptoms. The most characteristic of the latter are delusions, incl. delusions of guilt, nihilistic or hypochondriacal. Often times, psychotic depression is not properly diagnosed - patients are sometimes diagnosed with a depressive disorder itself or another condition. Then the treatment does not bring the expected results. So how do you know if you are suffering from psychotic depression?
Contents:
- Psychotic depression: causes
- Psychotic depression: symptoms
- Psychotic depression: recognizing
- Psychotic depression: treatment
- Psychotic depression: prognosis
Psychotic depression(depression with psychotic symptoms) is a rather obscure psychiatric problem. Doubts concern even whether it is really one of the possible types of depression, or whether it is in fact a completely separate disease entity.
These types of dilemmas arise, among others, in since yes - psychotic depression has many features in common with depressive disorders without psychotic symptoms - but there are many differences.
Psychotic depression is seen in patients of all ages (including children and the elderly), but typically its first episode occurs between the ages of 20 and 40.
Due to the fact that not all patients are properly diagnosed, the exact prevalence of this form of depressive disorders is difficult to estimate, however, the suggested frequency of depressive disorders with psychotic symptoms is 0.4% in the general population, and among all of patients treated for depression, from about 15 to 25% of them may suffer from psychotic depression.
Psychotic depression: causes
Depression with psychotic symptoms can appear in the course of both unipolar and bipolar disorder (BD).
A problem of a similar type specific only to women is puerperal psychotic depression (in which psychotic symptoms, combined with depressive symptoms, appear after childbirth).
Not reallyit is understandable why some patients with depressive disorders develop psychotic symptoms.
Genes are suspected of a connection with this problem - hypotheses of this type arose from the fact that in a situation where someone in the family of a given person suffered from psychotic depression or schizophrenia, there is a risk that they will also develop affective disorders with psychotic symptoms is increased.
Generally, psychotic depression can be caused by problems similar to that in the case of "typical" depressive disorders - we are talking here, inter alia, about abnormalities in the levels of neurotransmitters in the central nervous system or experiencing very difficult events for the psyche (which may include rape, persecution by other people or the death of a loved one).
Researchers analyzing the causes of psychotic depression quite often pay attention to certain abnormalities that are associated with this problem, and are not necessarily encountered in depression without psychotic symptoms.
We are talking about hormonal disorders - in the course of depression with psychotic symptoms it is quite common to find disturbances in the activities of the hypothalamic-pituitary-adrenal axis, which can lead to, among others, to excess cortisol in the body (excessive amounts of this hormone can be a potential source of psychotic symptoms).
Psychotic depression: symptoms
As mentioned at the very beginning, symptoms of psychotic depression are problems from two groups, i.e. typically depressive symptoms and psychotic symptoms.
In the case of the first of these, we refer to, inter alia, a significant decrease in mood, anhedonia, sleep disorders or a sense of loss of self-worth, a feeling of constant fatigue and appetite disorders.
Some researchers point out, however, that the ailments included in the depression spectrum, in the case of depressive disorders with psychotic symptoms, are, however, slightly different than in depression without such symptoms.
These scholars emphasize that in patients with psychotic depression there are clearly visible e.g. severe anxiety, psychomotor slowing down or cognitive disorders, and less frequent are circadian mood swings and early waking up.
However, the most characteristic feature of the symptoms of depression discussed here are psychotic symptoms, which typically include delusions and hallucinations. The former may or may not be compatible with the mood. Mood-related delusions are more common in patients with psychotic depression and may be:
- delusionsworthlessness
- nihilistic delusions
- delusions of guilt, sinfulness
- delusions of bodily illness
- catastrophic delusions
Delusions inconsistent with the mood in the case of psychotic depression are usually considered, among others, persecutory delusions and delusions.
As for the symptoms of psychotic depression, hallucinations, these are incorrect perceptions on the part of the sensory organs (e.g. in the form of hearing voices or seeing non-existent characters) and may include olfactory, auditory or sensory hallucinations.
Psychotic depression: recognizing
Psychotic depression is usually not easy to diagnose and for several reasons. First, some patients are partially critical of their ailments - e.g. they realize that they hear voices that do not really exist - and they are not inclined to tell their relatives or medical specialists about their symptoms. . Additionally, psychotic depression should be differentiated from various other psychiatric entities, the symptoms of which may be similar to those associated with depressive disorders with psychotic symptoms - the differential diagnosis should include, among others:
- schizophrenia
- schizoaffective disorder
- post-traumatic stress disorder
- mental disorders in the course of dementia disorders
- mental disorders related to somatic diseases
Generally, the diagnosis of psychotic depression is usually made when a concurrent coexistence of depressive disorders with psychotic symptoms is found, and when, in addition, the criteria for diagnosing another type of mental disorder (e.g. the aforementioned schizoaffective disorders or schizophrenia) are not met.
It is also important to diagnose the patient what kind of mental disorders he or she had in the past. Usually, psychotic symptoms - if at all - appear during the first episode of depression.
Psychotic depression: treatment
Proper diagnosis of psychotic depression is even crucial for the patients' condition - even when they are diagnosed with depressive disorders alone and the patient is given antidepressants, the patient's condition may deteriorate.
Generally, patients with depression with psychotic symptoms are rarely treated with only one preparation - usually a combination of an antidepressant (antidepressant) and an antipsychotic (AED) is used. Amongexamples of drug combinations used in this case can be mentioned:
- sertraline (LPD) with olanzapine (LPP)
- fluoxetine (LPD) with olanzapine (LPP)
- amitriptyline (LPD) with perphenazine (LPP)
- venlafaxine (LPD) with quetiapine (LPP)
Important in the treatment of psychotic depression is, however, not only pharmacotherapy, but also psychotherapy - it is generally believed that the best results of therapy can be obtained through the combined use of both methods. In addition to the methods already mentioned, electroconvulsive therapy is also performed in depressed patients with psychotic symptoms.
Psychotic depression: prognosis
The exact prognosis of patients with psychotic depression is difficult to determine, but they are rated worse than the prognosis of those who suffer from depressive disorders without psychotic symptoms.
As in the case of other types of depression, also in depression with psychotic symptoms its course is usually episodic, i.e. the patient experiences periods in which he experiences symptoms of a mental disorder, as well as episodes in which he does not struggle with he is dealing with this type of ailments.
It is estimated that complete remission is achieved in about half of all treated patients, while in the remaining patients there is sometimes a noticeable improvement in their complaints.
About the authorBow. Tomasz NęckiA graduate of medicine at the Medical University of Poznań. An admirer of the Polish sea (most willingly strolling along its shores with headphones in his ears), cats and books. In working with patients, he focuses on always listening to them and spending as much time as they need.