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Psychotic Depression - what is it, symptoms, diagnosis and treatment.

An Introduction To Psychotic Depression

Depression features as one of the natural human responses to stressful life events such as death in the family, bankruptcy etc. It is characterized by a low yet continual state of sadness and gloom, with physical manifestations in form of aversion towards work, lack of motivation etc. But when this disturbed mood state persists in a person for two weeks or more despite the absence of any stressor; it then becomes a major depression disorder.

Psychotic depression falls in the atypical category of major depression where the individual experiences psychotic symptoms while demonstrating general depressive behavior. As a result, the person’s sense of perception of the real world becomes distorted.

What Is Psychotic Depression?

Psychotic depression or PD generally occurs in the form of episodes where the marquee symptoms are psychotic in nature. These primarily involve hallucinations and delusions. Both these aspects are explained below:

•  Hallucinations – A person diagnosed with PD would often hear voices in his or her head, which can be quite threatening or critical. Sometimes, these voices can be accusatory in nature and thus induce suicidal tendencies in the subject. Visual hallucinations, while less common may also be experienced during such depression episodes.

•  Delusions – This refers to the ‘break from reality’ phase wherein the brain misinterprets natural phenomena or events and produces feelings or thoughts incoherent with the real world. Delusions of guilt, persecution, worthlessness, and impending disaster are commonly seen with PD patients.

Symptoms of Psychotic Depression

Apart from hallucinations and delusions, other familiar PD symptoms include the likes of Anhedonia (inability to experience pleasure), intellectual impairment, feeling of incapacitation, loss of interest and constipation among other things.

Another very unique set of symptomalogy are psychomotor disturbances, which primarily give rise to cognitive dysfunction, rumination and anxiety in a person. Psychomotor dysfunction serves as an important demarcation between psychotic and general depression.

A person diagnosed with psychotic disorder may also exhibit drastically opposite symptoms. For instance, the individual might be hyperactive one day and extremely sluggish the next. Sleep ability too gets affected in the same manner where both insomnia (inability to sleep) and hypersomnia (excessive sleepiness) tend to occur in an oscillatory manner in the individual.

PD Diagnosis – The Challenges Faced

From the above section, it becomes quite clear that PD patients exhibit characteristics related to both depression as well as psychosis. As a result, the mood disorder has a very low rate of diagnostic stability simple because it can be misinterpreted as Schizophrenia, schizoaffective disorder or even a different form of major depressive complication.

 In addition, subjects themselves shun away from taking professional help owing to feelings of extreme guilt, humiliation and other excessively negative emotions. Yet there are other cases where episodes have such small time spans that it becomes difficult to ascertain if the person actually suffers from PD or another form of major depression.   

Therefore, an expert diagnosis of PD is only possible in a hospital setting or through regular sessions done with a psychologist or psychiatrist.

Given the diverse nature of the disorder, PD treatment too is equally versatile and includes options such as medication, counseling and electroconvulsive therapy. In most patients, full recovery can be seen within one year or so from the time treatment first began. As far as medication is concerned, antidepressants and antipsychotics are administered for stabilizing the mood disorder. 

However, in light of the low response rate of antidepressants when used as standalone therapy for PD as cited by recent studies; increasing number of psychiatrists today either depend on antipsychotic monotherapy (treatment using a single class of drug) or a combinational therapy involving both antidepressants and antipsychotics. 

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