Depression is a complex disorder – one characterized by a spectrum of symptoms. The existence – or absence – of a specific defining symptom can completely alter the diagnosis. In the case of psychotic depression, also known as delusional depression, Medline Plus reports that the condition is much like major depression in terms of how it manifests in patients but with one unique characteristic: patients often lose touch with reality during psychotic episodes, experiencing delusions, believing adamantly that certain things are true that are not true, or experiencing hallucinations – seeing or hearing things that are not there.
Why does this happen to some who experience depression and not others? No one is certain. It could be a combination of factors, including genetics, environment, and/or neurological/biological factors.
Psychotic depression is a serious disorder, one that is made worse by the use of drugs and alcohol. When a patient is struggling with both a substance use disorder and psychotic depression, treatment is immediately necessary and a program that can effectively address both disorders simultaneously is recommended.
Complications Caused by Psychotic Depression
Patients living with psychotic depression often find it difficult, if not impossible, to function in the world or interact positively with their families. Often, they will experience symptoms such as:
- Frequent crying spells that are without cause
- Deep depression that stops them from going to work or school – and often, from even getting out of bed
- Auditory hallucinations
- Suicidal thoughts
Some patients attempt to medicate the issue on an outpatient basis with little support or monitoring from a medical team that specializes in the treatment of psychosis. Unfortunately, this can be dangerous. For example, if the medications are ineffective or cause side effects, the patient may be unable or unwilling to report the problem, which can increase the risk of suicidal behaviors, substance abuse or both.
Treatment of Psychotic Depression
Studies are often released exploring different options in medication for the treatment of psychotic depression. One study published by the National Institute for Mental Health (NIMH) explored the option of prescribing an atypical antipsychotic medication in addition to an SSRI antidepressant medication as opposed to an antipsychotic medication alone. They found that, though about 45 percent of the study participants dropped out of the study, the dropout rate was lower among the group that was prescribed the combination of medications as opposed to those taking the single medication.
Inpatient Dual Diagnosis Treatment
Though some forms of depression may be effectively treated on an outpatient basis, it is recommended that patients who are struggling with psychotic depression seek residential Dual Diagnosis treatment, especially if substance abuse is also an issue. The benefits are many and include:
- Increased efficacy of care. When multiple disorders are present, the patient will require effective treatment for all applicable conditions. Getting care for multiple disorders at the same time increases the ability of the patient to heal without the symptoms of the untreated disorder getting in the way of the focus of treatment.
- Decreased chance of dropping out. Dropout rates are commonly an issue for patients who suffer from psychosis in any form, especially when they seek care on an outpatient basis. Residential treatment provides more support and assistance, which can reduce the dropout rate.
- Around-the-clock monitoring. In order to ensure that patients don’t suffer complications due to detox from their drug of choice or use of new medications for the treatment of psychosis, 24-hour monitoring is beneficial.
- Personalized treatment. Adjusting treatment, therapies, medication and other aspects of care to the needs of the specific patient is far easier done when patients are in constant contact with their providers.
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Further Reading About Psychotic Depression
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.