What Is Depressive Psychosis?

According to the National Alliance on Mental Illness (NAMI), an estimated 20 percent of people who have major depression also have psychotic symptoms. This combination is known as depressive psychosis. Some other names for the condition are:

  • delusional depression
  • psychotic depression
  • major depressive disorder with mood-congruent psychotic features
  • major depressive disorder with mood-incongruent psychotic features

This condition causes you to experience psychotic symptoms plus the sadness and hopelessness associated with depression. This means seeing, hearing, smelling, or believing things that aren’t real. Depressive psychosis is especially dangerous because the delusions can cause people to become suicidal.

A person who experiences depressive psychosis has major depression and psychotic symptoms. Depression occurs when you have negative feelings that affect your daily life. These feelings can include:

  • sadness
  • hopelessness
  • guilt
  • irritability

If you have clinical depression, you may also experience changes in eating, sleeping, or energy levels.

Examples of psychotic symptoms include:

  • delusions
  • hallucinations
  • paranoia

According to the Journal of Clinical Psychiatry, delusions in depressive psychosis tend to be guilt-ridden, paranoid, or related to your body. For example, you may have a delusion a parasite is eating your intestines and that you deserve it because you’re so “bad.”

Depressive psychosis doesn’t have a known cause. In some people, it’s thought that a chemical imbalances in the brain is a factor. However, researchers haven’t identified a specific cause.

According to NAMI, depressive psychosis may have a genetic component. While researchers haven’t identified the specific gene, they do know that having a close family member, such as a mom, dad, sister, or brother, increases your chances of having psychotic depression. Women also tend to experience psychotic depression more than men.

According to the journal BMC Psychiatry, older adults are at greatest risk for psychotic depression. An estimated 45 percent of those with depression have psychotic features.

Your doctor must diagnose you with major depression and psychosis for you to have depressive psychosis. This can be hard because many people with psychotic depression may be afraid to share their psychotic experiences.

You must have a depressive episode that lasts two weeks or longer to be diagnosed with depression. Being diagnosed with depression also means you have five or more of the following symptoms:

  • agitation or slow motor function
  • changes in appetite or weight
  • depressed mood
  • difficulty concentrating
  • feelings of guilt
  • insomnia or sleeping too much
  • a lack of interest or pleasure in most activities
  • low energy levels
  • thoughts of death or suicide

In addition to these thoughts associated with depression, a person with depressive psychosis also has psychotic symptoms, such as delusions, which are false beliefs, and hallucinations, which are things that seem real but that don’t exist. Having hallucinations can mean you see, hear, or smell something that isn’t there.

Psychotic depression is often considered a psychiatric emergency because you’re at an increased risk for suicidal thoughts and behavior, especially if you hear voices telling you to hurt yourself. Call 911 immediately if you or a loved one has thoughts of suicide.

Currently, there are no treatments specifically for depressive psychosis that are approved by the FDA. There are treatments for depression and psychosis, but there aren’t any specifically for people who have both of these conditions at the same time.


Your doctor may treat you for this condition or refer you to a licensed mental health professional who specializes in the use of medications for these conditions.

Mental health providers may prescribe a combination of antidepressants and antipsychotics. These medications impact neurotransmitters in the brain that are often out of balance in a person with this condition.

Examples of these medications include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac). This may be combined with an atypical antipsychotic, such as:

  • olanzapine (Zyprexa)
  • quetiapine (Seroquel)
  • risperidone (Risperdal)

However, these drugs take several months to be most effective.

Electroconvulsive Therapy (ECT)

The second treatment option is electroconvulsive therapy (ECT). This treatment is typically performed in a hospital and involves putting you to sleep with general anesthesia.

Your psychiatrist will administer electrical currents in controlled amounts through the brain. This creates a seizure which impacts your levels of neurotransmitters in the brain. This treatment does have side effects, including short-term memory loss. However, it’s thought to work quickly and effectively for people with suicidal thoughts and psychotic symptoms.

Your psychiatrist can discuss these options with you and your family to determine the best course of treatment for your condition. Because relapse is possible, your psychiatrist may recommend taking medicines after ECT as well.

Living with depressive psychosis can feel like a constant battle. Even if your symptoms are under control, you may be concerned they’ll come back. Many people also choose to seek psychotherapy to manage symptoms and overcome fears.

Treatments can help reduce psychotic and depressive thoughts, but they can have their own side effects. These include:

  • short-term memory loss
  • drowsiness
  • dizziness
  • trouble sleeping
  • changes in weight

However, you can live a healthier and more meaningful life with these treatments than you can without them.

If you think someone is at immediate risk of self-harm or hurting another person:

  • Call 911 or your local emergency number.
  • Stay with the person until help arrives.
  • Remove any guns, knives, medications, or other things that may cause harm.
  • Listen, but don’t judge, argue, threaten, or yell.

If you think someone is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.

Sources: National Suicide Prevention Lifeline and Substance Abuse and Mental Health Services Administration