Major Depressive Disorder is defined as:
Psychotic Features include
Major depressive disorder with psychotic features is almost always considered a severe form of depression due to its debilitating symptoms. For this disorder, the sufferer will show symptoms of both depression and psychosis.
Severe depression is debilitating in that the person can feel so miserable, worthless, hopeless, guilty, ugly, or like a failure that they lack the desire to do anything productive or anything that feels good. Severe depression is often accompanied by thoughts of death, and sometimes of suicide. It can also include delusions, or hallucinations.
Psychotic features can vary in rage and in intensity but can include someone who appears to believe things that don't seem to be valid. Like believing they are to blame for something that they actually had nothing to do with. This would be a delusion, or a belief in something contrary to factual evidence.
Someone who has psychotic features might also suffer from hallucinations which could take place in any of our senses. They could be looking around the room as if they are watching things but other people can not see anything there. They might turn and look as if they heard something, but no noise was heard to other people in the room. They can also smell things that are not there, feel sensations like an itch or if someone just passed them by, or they might taste something odd or strange.
While all of the above symptoms could occur with psychotic features, the most common example of major depressive disorder with psychotic features is one like the example given – the individual is depressed and is overwhelmed with guilt or shame over something that they did not have control of, did not do, or could not have changed.
There are two types of categories when discussing causes of depression
Situational depression is by far the most common type of depression. In my years as a clinical psychotherapist I have only seen a handful of cases that were solely chemical in nature.
Situational depression is caused by an inconsistency between our core beliefs and our conscious mind. Our subconscious minds try live our lives by the rules outlined in our core beliefs but our conscious minds try to live lives by what we experience and learn. When one side of our minds is unwilling to budge and unwilling to learn or change (usually the subconscious) and the other side is constantly changing and learning (consciousness) – there are many opportunities for the two to disagree. We call these “inconsistencies”.
When these inconsistencies happen, our minds use tactics to help keep the two parts of our mind in balance. Often times these tools are in the form of guilt or shame. The idea is that if we hurt ourselves bad enough, our minds believe that we won't make the same mistakes again – or that if we hurt ourselves bad enough we wont forget a mistake, or even that if we hurt bad enough it will motivate us to improve or change. However, if our minds use these tools too much or too often, the results can backfire. The negative and hurtful tools end up sending us into a depression, and very little improvement actually happens.
Lets take for example, we have someone who has two rules by which they must live life (subconscious).
Now lets say that we run into someone in our life that is hurting us. What do we do? If we tell them they are hurting us, we are going against the rule “I can never hurt anyone” - and if we don't say anything then we are going against the rule “I must protect myself at all times”. No matter what choice we make, our subconscious and conscious minds are not going to disagree; and when they don't agree they will use tools to try and get us to change. The results of our minds trying to “change” are depression symptoms.
The psychotic features in Major depressive disorder with psychotic features come from the depressive state. In psychology we need to be able to tell the difference between someone who is psychotic first, and depressed because they are experiencing psychotic symptoms, from someone who is depressed and having psychotic features because of their depression. Because you have landed on this diagnosis, this means that the psychosis is likely caused by your depression.
Major depression, even depression that is situational depression, changes the brain chemistry in the individual and alters the way that they view themselves and the world around them. When the chemistry changes enough, or if their view of themselves or the world gets altered far enough, they start to experience psychosis.
It is important to involve your primary care physician in your decisions about depression. Whatever choice you make about your treatment, our recommendation for depression is always a combination of medication and guided help from one of our guides, or a local therapist. Studies have shown over and over that combining these two forms of treatment outperforms either one of them done individually.
It is also important for you to know that while many people choose medication as their only form of treatment for depression – medication has been shown to have a higher rate of your depression returning, in addition to many side effects that are not present with some form of talk therapy.
The belief behind major depressive disorder with psychotic features is that if you treat the underlying depression – the psychotic features will dissipate as well. Therefor the treatment options are usually the same as with a severe case of major depression. However, if the psychotic features become bad enough, your physician may decide to put you on a different type of medication to help control them.
It is extremely important with someone suffering from psychotic features, and depression, that they work closely with a professional. It can be very hard for them to think clearly at times, to take medication as prescribed, and they have a higher than average rate of suicidal thinking.
Severe Depression with Psychotic Features Treatment Options include: