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What is Psychotic Depression? Symptoms and Treatment Options

A silhouette of a person with their head down with wadded up pieces of gray paper coming out of the top of their head.

Psychotic depression is the most severe form of depression. As the name implies, it causes people to have psychotic episodes, like hallucinations and delusions. Because it can cause a person to break from reality, treatment options tend to be more invasive.

Symptoms of Psychotic Depression

People with clinical depression can evolve and develop psychoses. Depression symptoms usually include:

  • Hopelessness
  • Sadness
  • Loss of enjoyment in activities you once enjoyed
  • Avoidance of social events
  • Lack of interest in your appearance
  • Loss of appetite or inability to quell overeating
  • Insecurity and anxiousness
  • Feeling insignificant
  • Anger or irritation

People suffering from depression often feel sluggish, sleep more, or just find it difficult to get out of bed. They wrestle with feelings of guilt, despair, and cynicism. Instead of lessening or remaining stagnant, depression for some people leads to psychotic events, like:

  • Seeing people or objects that aren’t really there
  • Hearing voices
  • Smelling or tasting things that don’t exist
  • Becoming paranoid about others and assuming strangers and loved ones think you’ve gone crazy
  • Suspecting that someone wants to hurt you

Psychotic episodes are often so debilitating that you begin to believe your only escape is through suicide.

Treatment of Psychotic Depression

When your depression leads to a break with reality, you will likely need a combination of medical help and therapy. Your therapist might urge you to check yourself into a mental institution for a while, especially if they have reason to believe you will hurt yourself or others.


Doctors often prescribe a mix of antidepressants and antipsychotics to treat psychotic depression. Common antidepressants prescribed are selective serotonin reuptake inhibitors (SSRIs), and include:

  • Prozac
  • Lexapro
  • Zoloft
  • Paxil
  • Celexa

Antipsychotics, which regulate neurotransmitters in the brain by either increasing or reducing them, are frequently used when treating severe forms of depression. Doctors commonly prescribe:

  • Clozapine
  • Olanzapine
  • Paliperidone
  • Quetiapine
  • Risperidone

While a number of patients are successfully treated with medication, it can take months before you respond positively to drugs. For those who don’t feel they can wait that long, electroconvulsive therapy (ECT) could be an effective treatment.

Electroconvulsive Therapy

Electroconvulsive Therapy (ECT) is also a popular treatment for people with psychotic depression. Patients are admitted to a hospital and given a general anesthesia to put them to sleep. Their brain is exposed to electrical currents that cause small seizures used to shift your levels of neurotransmitters.

Although it can cause side effects like short-term memory loss, many people have found that ECT left them feeling more like themselves in a remarkably short period of time.


Even if you’re on antidepressants, you may want to seek help from a depression counselor as well. Because people who experience psychotic depression have a high chance of it recurring, they may benefit from having an outlet they can turn to if they feel their medication is not working or their hallucinations come back.

Also, people who suffer from depression, and especially psychotic depression, often have thoughts of suicide. If you’re thinking about harming yourself, immediately call your therapist for help.