You believe you’re going mad. You’ve somehow managed to weather your major depressive episodes. But when the voices and delusions began, you were sure you’d fallen into an abyss. Psychotic features in major depressive disorder are terrifying. But knowledge encourages calm. Here’s what you need to know…
Our friend is having a rough go. He’s already enduring a major depressive episode. but now he’s hearing voices. Yesterday it was delusions. He knows something is horribly wrong – and he’s terrified. Let’s get him some information and support.
If you look at the major depressive disorder (MDD) diagnoses in the American Psychiatric Association’s DSM-5, you’ll bump into the term “with psychotic features” twice: major depressive disorder, recurrent episode, with psychotic features and major depressive disorder, single episode, with psychotic features
It’s that three word term we’re going to discuss. FYI, our focus here will be upon psychotic features, not MDD. Bone-up on MDD, if you’d like.
What are psychotic features in major depressive disorder?
First and foremost, if you’ve been diagnosed with MDD, experiencing psychotic features doesn’t automatically mean your diagnosis is going to be changed to one of the DSM-5‘s Schizophrenia Spectrum and Other Psychotic Disorders. Out of respect for those who have such a diagnosis, life would certainly go on.
Major depressive disorder with psychotic features is also referred to as psychotic depression. It’s believed that 15-20% of those diagnosed with MDD experience psychotic features. It seems to become more common as people age.
No doubt about it, it’s a troubling condition that merits the immediate and ongoing care of a medical professional – I believe a psychiatrist. And a therapist can be very helpful.
So what are the psychotic features? In MDD, most often these two…
- Hallucination: a sensory perception (such as a visual image or a sound) that occurs in the absence of an actual external stimulus. My clinical experience says hearing voices is most common.
- Delusion: a persistent false psychotic belief regarding the self or persons or objects outside the self that is maintained despite indisputable evidence to the contrary. In the case of MDD with psychotic features, the delusions are often persecutorial – paranoid thinking that others are out to harm the individual.
Disorganized or disordered thinking may also be a psychotic feature. But, keep in mind, it’s way more intense than issues with thinking, concentration, and decisiveness.
Okay, it’s important to understand there are two different types of psychotic features in MDD…
- Mood-congruent: the content of the hallucinations and delusions are consistent with typical depressive themes – guilt, worthlessness, hopelessness, inadequacy, failure, etc.
- Mood-incongruent: the content of the hallucinations and delusions don’t involve typical depressive themes
Some individuals experience both.
What’s most important here is hallucinations and delusions can be extremely scary – even dangerous. Fact is, suicidal ideation and behavior may make the scene. For that reason I’ve included information regarding the National Suicide Prevention Lifeline at the end of the article.
By the way, psychotic features can also be a factor in bipolar disorder.
What causes psychotic features in major depressive disorder?
Like most anything else in the emotional and mental health world, the bottom-line cause of psychotic features in major depressive disorder is largely a mystery.
Though it isn’t a true cause, it’s helpful to know that individuals with a family history of depression or psychotic depression, especially parents and siblings, are more likely to develop them.
More to true cause, it’s believed that a combination of genes and stress can generate the production of certain chemicals in the brain that contribute to psychotic features. And it’s thought that the stress hormone, cortisol, may be involved. It’s significant that high levels of cortisol are often found in people with depression.
That’s about all I can offer. However, research – hope – really does continue.
How are psychotic features in major depressive disorder treated?
The first-line treatment for MDD with psychotic features is a combination of an antidepressant and an antipsychotic. The antipsychotics prescribed will most likely be of the newer – atypical – class, which have a much better side effect profile than the original antipsychotics. Electroconvulsive therapy (ECT) is also considered a first-line treatment.
When it comes to meds, risks are always involved. And that’s especially the case when combining an antidepressant and an antipsychotic. My money says your psychiatrist is aware of the risks and will take care in prescribing. A physical examination and blood work may be requested.
In addition to meds, if chosen, therapy is a great intervention for MDD with psychotic features. I mean, one is likely to be seeing a therapist anyway for depression, so why not receive help with managing hallucinations and/or delusions? Such work can be of great assistance.
Let’s wrap it up
Though the presence of psychotic features in major depressive disorder is the exception, it needs to be part of the conversation here on Chipur. As with any other condition we address, education – facts – bring relief.
If you’ve been diagnosed with major depressive disorder with psychotic features, stay on course with your psychiatrist and therapist. It’s that important. And if psychotic symptoms are presenting for the first time, no matter the circumstances, seek medical attention immediately.
Perhaps you find this article relevant because someone you know or love is experiencing psychotic features with their major depressive disorder. Please, share the piece with them.
Never forget, major depressive disorder with psychotic features is a manageable set of circumstances – with diagnosis, treatment, and monitoring. As with anything we discuss, action speaks louder than words.
Okay, the National Suicide Prevention Lifeline: 800.273.8255. Check-out their site for deaf and hard of hearing and language options, as well as even more important information.
Plenty more articles in the Chipur stable. Learn and find relief from one or more of the hundreds.