Depression with Psychotic Features

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This is the most severe and dangerous type of depression with the highest rate of suicide, aggression, and need for hospitalization. The victims lose their grip on reality and experience either wildly distorted beliefs (delusions) or wildly distorted perceptions (hallucinations). They need hospitalization and aggressive treatment to get them back to reality.

Typically, the delusions or hallucinations are filled with negative feelings about themselves. They may be convinced that they are responsible for the ills of the world. They may feel that their insides are "rotting out." They may hear voices calling their name, cursing and criticizing them, saying they deserve to die, or rehashing past misdeeds.

People with psychotic depression are at the highest risk to hurt themselves and other people. They have a potentially deadly combination: low self- esteem, poor judgment, delusional thinking, and hallucinations.

The initial goal of treatment is to eliminate the psychotic symptoms as quickly as possible. This usually involves taking the combination of an antipsychotic medication and an antidepressant medication. If this does not work, electro convulsive therapy (ECT) is indicated, that has a 95 percent chance of success. This depressions is very severe and dangerous. Stay on the medication for a long time to avoid possible recurrences.

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