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Major depression with psychotic features

Alternative names

Psychotic depression; Delusional depression


This is a condition in which depression is associated with delusional thinking and/or hallucinations. See major depression -- also see psychosis .

Causes, incidence, and risk factors

There are no obvious risk factors, though it is known that those with a family history of depression or psychotic illness will be more susceptible.


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

The content of these delusions and hallucinations is consistent with depression. For example, some people hear voices criticizing them, telling them that they are inadequate 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.

Signs and tests

A clinical evaluation consisting of an interview, a physical examination, and laboratory tests are used to make the diagnosis. Other medical conditions that can cause the same symptoms (such as reactions to certain drugs) should be ruled out.


Treatment usually is a more aggressive approach towards both the depression (with antidepressants) and psychosis (with antipsychotics).

The antipsychotics are sometimes given only temporarily. Electroconvulsive therapy is very effective for this condition, but it is generally a second line treatment.

Expectations (prognosis)

The presence of psychotic features in major depressive disorder reflects severe disease and is a poor prognostic factor. However, short-term success is common. A return of symptoms is to be expected.

Generally, the depressive symptoms have a much higher rate of recurrence than the psychotic symptoms. Patients may need to take medication for a long time in order to prevent recurrence.


Suicide or other self-harm is the most serious complication. Patients may need to be hospitalized if they have thoughts of suicide.

Calling your health care provider

Call your health care provider if you suffer from either depression or psychosis.

Update Date: 5/13/2002

Yvette Cruz, M.D., Department of Psychiatry, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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Last updated: Tue, 06 Jan 2009 00:20:03 GMT