Fragments of Reality: A Deep Dive into Psychotic Depression

Fragments of reality: a deep dive into psychotic depression.

Psychotic depression, kind of like schizophrenia…but not. I can look at it from a schizophrenic view, but it is slightly different than that.

I had intrusive thoughts this morning, which I thought was going to start an episode, but it didn’t…so far. Very weary.

Once you have your first psychotic episode, you fear the next one. Kind of like panic attacks, only they don’t last as long.

What defines psychotic depression? 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.

Factors Associated With Psychotic Depression

Fragments of reality: a deep dive into psychotic depression. The cause of psychotic depression is not fully understood, but some factors that may be associated with it include:

Genetics: Undoubtedly, severe depression can run in families, and genes likely play a role.
Life events: Personal circumstances and life events can trigger psychotic depression, such as bereavement, relationship problems, financial problems, health problems, and traumatic experiences.
Ethnicity: Patients with psychotic depression are more likely to be non-Caucasian.
Residence: Concurrently, patients with psychotic depression are more likely to live in rural areas.
Parental mental illness: Patients with psychotic depression are more likely to have a family history of mental illness, especially parental mental illness.
Bipolar disorder: Patients with psychotic depression are more likely to have family members with bipolar disorder.
Stress: At the same time, stressful life events and trauma, both in childhood and before a psychotic episode, are associated with psychosis.

Other Factors That Can Contribute to Psychosis Include:

Firstly, sleep deprivation
Certain prescription medications
Misuse of alcohol or drugs
Physical conditions, such as a brain tumor or dementia
Head injury
Lastly, childbirth

What Are the Delusions of Psychotic Depression?

Fragments of reality: a deep dive into psychotic depression.

Even more, psychotic depression, also known as major depressive disorder with psychotic features, can involve various delusions and hallucinations.

Associating with this condition, here are some common types of delusions :

Paranoid Delusions: Generally, individuals may believe that others are plotting against them or trying to harm them, leading to feelings of distrust and isolation.
Guilt or Worthlessness Delusions: Some may experience intense feelings of guilt or believe they are responsible for negative events, often leading to a distorted self-image.
Somatic Delusions: These involve false beliefs about one’s body, such as believing they have a serious illness or that their body is rotting or in some way defective.
Delusions of Reference: Individuals might think that common elements of the environment, such as television shows or conversations, are directly related to them or contain hidden messages.
Grandiose Delusions: Although less common in psychotic depression, some may experience inflated self-esteem or believe they have special powers or abilities.
Religious Delusions: Although, some may hold beliefs that they have a special connection to a deity or that they are being punished or tested by a higher power.
Catastrophic Thinking: This involves believing that the worst possible outcomes will occur, often leading to a sense of impending doom.

Therefore, these delusions can significantly impact a person’s perception of reality and their ability to function in daily life.

Psychotic Depression Symptoms

If you have MDD with psychosis, you’ll have symptoms of both major depression and psychosis.

The Symptoms of Major Depression Include:

firstly, a persistent low, empty, sad, or hopeless mood (some people may believe life is no longer worth living, but others might feel more irritable than sad)
loss of interest and pleasure in activities you used to enjoy
Thirdly, sudden or unexplained changes in appetite and weight
sleeping difficulties, including sleeping much more or much less than usual
less energy than usual or lingering fatigue
additionally, changes in movement, such as an increase in restlessness or a sense of slowing down
difficulty concentrating or making decisions
frequent feelings of worthlessness, helplessness, self-hatred, or guilt
lastly, frequent thoughts of death, dying, or suicide

Psychosis involves a break or disconnect from reality, so people experiencing it aren’t necessarily aware of their symptoms, which can include:

firstly, hallucinations, or seeing, hearing, and feeling things that aren’t real
delusions, or believing things that aren’t true
psychomotor impairment, or slowed thoughts, movements, and feelings
lastly, a state of stupor, where you’re unable to move, speak, or respond to your environment

Psychotic Hallucinations and Delusions Might Involve:

firstly, believing you have a serious health concern, despite multiple tests showing otherwise
believing you have unique or special powers
thirdly, believing you’re a famous person or historical figure
hearing voices criticizing or mocking you
seeing a frightening or threatening animal following you
lastly, paranoia, or an irrational or extreme suspicion of other people

Delusions, with or without hallucinations, happen more often than hallucinations alone in people experiencing psychotic depression.

Even so, experts separate MDD with features of psychosis into two categories:

MDD With Mood-Congruent Psychotic Features

Fragments of reality: a deep dive into psychotic depression. Hallucinations and delusions reflect feelings and emotions that often show up with depression, including feelings of personal inadequacy, worthlessness, guilt, and fears about illness or death.

MDD With Mood-Incongruent Psychotic Features

However, hallucinations and delusions conflict with depression-related emotions. You might hallucinate a loved one, hear voices praising you, or smell something pleasant.

You might also believe someone is trying to chase you, kidnap you, or control your thoughts.

Psychotic Depression Treatment

Medicine for Psychotic Depression

Ketamine and Lithium are often in use for psychotic depression.

Ketamine For Psychotic Depression

Study data suggested that short-term ketamine treatment for depression, as well as for negative symptoms, among patients with a history of psychosis or current psychotic features was generally safe and effective, with mild and self-limiting side effects.

They observed no psychotic complications among patients in the included cases.

Some cases featuring improvement in or disappearance of co-occurring psychotic symptoms after ketamine was used for depression.

Lithium for Psychotic Depression

Lithium can be effective treatment for depression with psychotic features. Subsequently, lithium can be in use in a number of ways, including:

Augmentation: Likewise, lithium can help patients who don’t respond well to antidepressants.
Continuation treatment: In addition, lithium can be used after electroconvulsive therapy (ECT) to prevent relapse.
Prophylaxis: Using lithium to prevent recurring episodes of depression.

Notwithstanding, lithium is especially recommended for patients who have severe depression and a high risk of suicide.

It may be more effective for patients with: A history of more than three major depressive episodes, Weight loss, Psychomotor retardation, and A first-degree relative with a mood disorder.

Although, Lithium can take several weeks or months to work.

Some people may experience side effects such as nausea, vomiting, dizziness, headache, insomnia, asthenia, constipation, diarrhea, tremor, and weight gain.

Therapy For Psychotic Depression

Cognitive Behavioral Therapy (CBT)

Fragments of reality: a deep dive into psychotic depression. This type of one-on-one talking therapy can help some people with severe depression, including those with psychosis.

Overall, CBT treatment usually involves efforts to change thinking patterns.

These strategies might include: Learning to recognize one’s distortions in thinking that are creating problems, and then to reevaluate them in light of reality.

Also, gaining a better understanding of the behavior and motivation of others.

Social support

Support with social needs, such as education, employment, or accommodation.

Family and friends support is also necessary if possible. Having someone on your side is a big positive when you need someone to talk to.

Help is available

Speak with someone today

988 Suicide and Crisis Lifeline

Languages: English, Spanish

Hours: Available 24 hours

Psychotic Depression vs Schizophrenia

Psychotic depression and schizophrenia are both mental illnesses that can cause psychotic symptoms, but they differ in several ways, including:

Episodic Symptoms

Psychotic symptoms in major depressive disorder with psychotic features are only present during a depressive episode, while schizophrenia symptoms occur without a mood disorder.

Age of Onset

The first episode of psychosis in psychotic depression usually occurs between the ages of 18 and 25, but can occur between 15 and 40.

Schizophrenia is typically diagnosed in the late teens to early thirties, and usually occurs earlier in males than females. I actually don’t remember when I was diagnosed.

My teens and twenties and even thirties are a blur because of ECT. I hardly remember a thing during those years.

Treatment

Psychotic depression requires immediate medical care and treatment, usually involving a combination of antidepressants and antipsychotics.

Subsequently, schizophrenia is a chronic condition that is usually treated with a combination of medications, psychological therapy, and social therapy.

Not anymore, all I have is meds due to inflation. We’ll see if I can afford my meds. Psychiatrist and therapist are gone. My GP is handling all my meds now.

Causes

Fragments of reality: a deep dive into psychotic depression. The causes of psychotic depression and schizophrenia are not fully understood, but research suggests that both involve a combination of factors.

In brief, some other symptoms of psychotic depression and schizophrenia include:

Psychotic Depression

Agitation, anxiety, constipation, hypochondria, insomnia, intellectual impairment, and physical immobility

Schizophrenia

Hallucinations, delusions, muddled thoughts and speech, and losing interest in everyday activities

Living with Psychotic Depression

I can tell you living with schizophrenia doesn’t have any dull moments. I imagine living with psychotic depression is the same although you’re depressed at the same time.

When I was living on my own after the first divorce, I was in a depression, but having delusions also. This was back in like 2009-2010.

I was living in a cramped one bedroom apartment with 3 cats. A lot of the time I just slept. Once in a while I would take a shower and get dressed.

But, that was when my delusions really took a turn for the worse. I stayed there for a year and I believe that’s how long the delusion lasted.

When I moved into a different apartment, another delusion started. I kept getting the police and paramedic’s called on my because I was suicidal most of the time.

Sum It All Up

Fragments of reality: a deep dive into psychotic depression.

When I left that apartment and moved in with my second husband’s house, the delusion’s became very personal. I had adopted a kitten after I moved in.

He became sick when he was 4 years old. Took him to the emergency vet just before the first of the year. She didn’t know what it was, but something was eating away his bones.

It was right before January1st, so I had him for two more days with a lot of morphine. I put him down on January 3rd.

The reason I say it got personal was because I remember watching him at times, and he would stare at something and was scared to death. He would hide all the time.

And then I started seeing images of this grotesque being on the camera screen facing the back parking lot at work. Other things started happening. Simultaneously, I started having panic attacks.

Anyway, when I moved to my dad’s house, the delusions stopped…until 6 months before my last cat was put down. Then, it stopped a few months after I put him down. You decide on what you think happened. Until next time…

Article About Psychotic Depression

-Psychotic depression

https://www.nhs.uk/mental-health/conditions/psychotic-depression/#:~:text=The%20delusions%20and%20hallucinations%20almost,sit%20still%2C%20and%20constantly%20fidgeting.

-Major Depression with Psychotic Features (Psychotic Depression)

https://www.healthline.com/health/depression/psychotic-depression#:~:text=Estimates%20based%20on%20community%20samples,53%20percent%20of%20older%20adults

-Psychosis & Schizophrenia Test

https://screening.mhanational.org/screening-tools/psychosis

Have a Good One,

Cindee Murphy
“One Voice Speaking From A Scizophrenic View”

“I am bent, but not broken. I am scarred, but not disfigured. Also, I am sad, but not hopeless. I am tired, but not powerless. I am angry, but not bitter. Therefore, I am depressed, but not giving up.” — Unknown

“Mental pain is less dramatic than physical pain, but it is more common and also harder to bear.” — C.S. Lewis

“I am in that temper that if I were under water I would scarcely kick to come to the top.” — John Keats

“Depression is being colorblind and constantly told how colorful the world is.” — Atticus Poetry

“It’s not always the tears that measure the pain. Sometimes it’s the smile we fake.” — Unknown