When Darkness Speaks: The Reality of Psychotic Depression

When darkness speaks: the reality of psychotic depression really hits home. You know, I truely don’t know what my “official” diagnoses are.

I’ve never really looked or asked my doctor. I just know the symptoms I have and go by that.

Besides, what’s the difference, they’re just labels. So, I’m psychotic (I know I have schizo) and in the past I’ve suffered from major depression.

Does that make me labeled as having psychotic depression? My point being, there are so many variation of diagnoses to different disorders, you can’t keep them straight (at least I can’t).

Maybe that’s why I’ve never asked. I don’t really care the name they give it so much as how I feel and deal with the symptoms.

That being said, psychotic depression is a serious mental disorder that combines depression with psychosis, or a loss of contact with reality.

Basically, it’s a subtype of major depressive disorder (MDD) that affects about one in four people admitted to the hospital for depression.

Major Depression With Psychotic Features

When darkness speaks: the reality of psychotic depression is a lot of people’s reality. People with other mental illnesses, such as schizophrenia, also experience psychosis.

But those with psychotic depression usually have delusions or hallucinations that are consistent with themes about depression (such as worthlessness or failure).

Psychotic symptoms in schizophrenia are more often bizarre or implausible and have no obvious connection to a mood state. For example, thinking strangers are following them for no reason other than to harass them.

People with psychotic depression also may be humiliated or ashamed of the thoughts and try to hide them (that ain’t me). Doing so makes this type of depression very difficult to diagnose.

Causes of Psychotic Depression

The exact causes of psychotic depression, also known as major depression with psychotic features, are not fully understood.

However, there are several factors that may increase the risk of developing the condition, including:

Genetics

Severe depression can run in families, and having a close family member with psychotic depression can increase your risk.

I believe my mother suffered from severe depression among other illnesses. Growing up, I always blamed her for all my problems, but she just was in a state where she couldn’t help herself.

And there are newer meds and other forms of treatments to combat psychotic depression nowadays.

Life Events

When darkness speaks: the reality of psychotic depression can stem from life events.

Personal circumstances such as bereavement, relationship problems, financial difficulties, health problems, and traumatic experiences can be triggers.

Hormonal Changes

Major hormonal changes, such as during menopause or the postpartum period, can increase your risk.

I’m not looking forward to this ‘change’ of life. I just hope it’s not to difficult to navigate through and come out on the winning side when it’s over.

Substance Abuse

Abusing substances like marijuana or methamphetamine can cause prolonged psychotic reactions, while alcohol can make depression symptoms worse.

Suddenly stopping drinking alcohol or taking drugs after long-term use can also trigger a psychotic episode, which is known as withdrawal.

Other Factors

Other factors that may increase your risk include not having close friends or loved ones to confide in, infrequent contact with friends and family,

Also, living with chronic pain or other chronic health conditions, and gender. Women and older adults tend to have a higher risk of developing psychotic depression.

Psychotic Depression Symptoms

When darkness speaks: the reality of psychotic depression has many symptoms.

Psychotic depression is a condition that includes symptoms of both depression and psychosis, which is a loss of contact with reality.

Symptoms of depression include:

Firstly, a persistent low mood, such as feeling sad, hopeless, or empty
Loss of interest in activities that were previously enjoyable
Changes in appetite and weight
Fourthly, difficulty sleeping
Low energy or fatigue
Difficulty concentrating or making decisions
Lastly, feelings of worthlessness, guilt, helplessness, or self-hatred

Symptoms of psychosis include:

Firstly, delusions, which are false beliefs about reality or one’s identity
Hallucinations, which are seeing or hearing things that aren’t there
Psychomotor agitation, which is an inability to relax or sit still
Lastly, psychomotor retardation, which is when thoughts and physical movements slow down

Other symptoms of psychotic depression include:

Anxiety, Constipation, Hypochondria, Insomnia, Intellectual impairment, and Physical immobility.

Also, people with psychotic depression may also have an increased risk of thinking about suicide.

How Long Does a Psychosis Depression Last?

People with psychotic depression are usually treated in a hospital setting with close monitoring from mental health professionals and medication to stabilize their mood.

This treatment is very effective, and people typically recover within several months.

However, some people may experience a difficult period that lasts for months or even years before things settle down.

The length of time someone is treated with antipsychotic medication may vary depending on their response to treatment.

For example, one study found that patients who responded to treatment with fluoxetine and perphenazine continued to receive the combination for an additional three months.

If patients were stable for four months, they were gradually tapered off perphenazine treatment. However, perphenazine was restarted if patients showed signs of impending relapse.

Depression and Delusions

When darkness speaks: the reality of psychotic depression can be a dark existence if you let it be.

When I was living by myself after my first divorce, something scary happened. I started to have serious delusions. And being depressed didn’t help.

I had the police and the fire department in the apartment on several occassions. Altogether, I believed some gang was trying to kill me.

I couldn’t tell you if it lasted the whole time I was there (1 year) or just part of the year. I only have certain memories of it and I lost track of time.

Consequently, it might have been the schizophrenia acting up, I don’t know. But I know I was very depressed and felt alone after the divorce.

Major Depression Hallucinations

During the time after my first divorce, I could hear (or so I thought) the police outside of my apartment trying to protect me from the gang.

I could hear them talking to me telling me everything was going to be ok. When they weren’t there, I could hear the gang membors (or the leader) speaking to me from behind one of the other buildings.

Emphatically, he kept threatening to shoot me if I stepped outside. So, naturally, I don’t think I ever left for a while. Like I said, I don’t know the time frame.

And then one day, I finally realized what was happening. Nonetheless, I moved once again, but the delusions started up again. So, I never really got away from them.

How to deal with someone with psychotic depression?

When darkness speaks: the reality of psychotic depression is hard to accept.

Here are some tips for supporting someone with psychotic depression:

Seek Help

If possible, call someone else for help. You can also reach out to the 988 Suicide and Crisis Lifeline for free and confidential support 24/7.

Stay Calm

Furthermore, avoid hostile, challenging, or disciplinary actions, and don’t raise your voice. Fidgeting, like shuffling your feet, can also make the situation worse. I do enough of that for the both of us.

Communicate Clearly

Use short sentences and speak in a calm, non-threatening voice. If the person is speaking in a disorganized way, repeat things if needed.

Be Empathetic

Undoubtedly, try to understand how the person feels about their experiences and beliefs, and validate their feelings of distress or frustration.

Don’t judge their beliefs or experiences, and avoid sarcasm or patronizing statements. Being judgemental only hurts the trust between both of you.

Listen

People with psychosis can feel isolated by their symptoms, so listening can help build a trusting relationship.

Just let them express their views and how they’re feeling. This can go a long way with them.

Offer Practical Help

Ask if they’d like help with something, like accessing a service or acting as an advocate.

Just being there as a friend is also a big help, but if they need help calling a professional, then by all means, help them.

Respect Their Wishes

When darkness speaks: the reality of psychotic depression is having a friend who listens.

Don’t try to make decisions for them, even if you think you know what’s best. Making decisions can only irritate them.

Therefore, if they only want your help at the time, then help them out by being a good listener.

Accept if They Don’t Want to Talk

If they don’t want to talk to you, be available if they change their mind. Sometimes, it has to be the right moment to talk.

When they feel safe, then they may be willing to talk. Having psychotic episodes is so hard to talk about because of the judgemental factor.

Psychotic Depression Treatment

Medications for Psychotic Depression

Generally, a combination of antidepressants and antipsychotics can help relieve symptoms.

Some say that a combination of a selective serotonin reuptake inhibitor (SSRI) and a second-generation antipsychotic (SGA) may be the best choice, particularly fluoxetine and olanzapine.

Selective Serotonin Reuptake Inhibitor

When darkness speaks: the reality of psychotic depression might be having to take meds.

Hence, SSRIs are often the first choice of medication for depression because they are generally considered safe and effective, and they typically cause fewer side effects than other antidepressants.

Some possible side effects of SSRIs include:

Firstly, Insomnia
Headaches
Rash
Fourthly, Blurred vision
Drowsiness
Dry mouth
Additionally, Agitation or nervousness
Dizziness
Pain in the joints or muscles
Lastly, Upset stomach, nausea, or diarrhea

SSRIs can also interact with other medications, including herbs and supplements.

Second-Generation Antipsychotics

Second-generation antipsychotics (SGAs), also known as atypical antipsychotics, are a class of drugs used to treat psychiatric conditions. Antipsychotics may only be needed for a short time.

SGAs are newer than first-generation antipsychotics (FGAs) and work differently by partially blocking dopamine receptors and possibly affecting serotonin.

SGAs are generally considered to have a lower risk of extrapyramidal symptoms and tardive dyskinesia than FGAs, but they may increase the risk of metabolic syndrome.

Metabolic syndrome can lead to weight gain, diabetes, high cholesterol, and high blood pressure, and can also cause cardiovascular events and liver or pancreatic dysfunction.

SGAs can also cause other side effects, such as sedation, indulge eating, impulse control disorder, and gambling.

Some examples of SGAs include:

Firstly, Aripiprazole (Abilify)
Asenapine (Saphris)
Brexpiprazole (Rexulti)
Fourthly, Cariprazine (Vraylar)
Clozapine (Clozaril)
Iloperidone (Fanapt)
In addition, Lurasidone (Latuda)
Olanzapine (Zyprexa)
Paliperidone (Invega)
Lastly, Risperidone (Risperdal)

Electroconvulsive therapy (ECT)

Comparatively, doctors may use ECT as a second-line treatment if medications don’t help. I did not have a very good outcome with ECT.

Most of my memory before that was wiped out and it didn’t work anyway. It’s up to you if you want to try it, just know the consequenses.

Talking therapies

At length, cognitive behavioral therapy (CBT) can be effective for some people with severe depression, including those with psychosis.

Social support

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

Sum It All Up

When darkness speaks: the reality of psychotic depression is not so bad once you accept it being a part of you.

So, I’m currently taking Olanzapine for my psychotic episodes. From this medicine, I developed tardive dyskinesia (or like Parkinson’s Disease).

Like I’ve mentioned previously, I don’t truely know all my diagnoses. Nor, do I care to know. I live my life to the best of my abilities and that’s it.

I know I’ve suffered through depression and schizophrenia, but I don’t recall if I’ve ever had psychotic depression. These are all just labels, it’s not who I really am.

After all I’ve been through all these years, you know what, I wouldn’t change a thing. I wouldn’t be who I am today, and I’m proud of who I’ve become. Until next time…

Articles About Psychotic Depression

-How Long Does Psychosis Last?

https://www.therecoveryvillage.com/mental-health/psychosis/how-long-does-psychosis-last/#:~:text=Psychotic%20disorders%20can%20last%20for,for%20six%20months%20or%20longer.

-Major Depression with Psychotic Features (Psychotic Depression)

https://www.healthline.com/health/depression/psychotic-depression

-Can Major Depression Cause Psychosis?

https://www.brightquest.com/major-depression/can-major-depression-cause-psychosis/

Have a Good One,

Cindee Murphy, One Voice In The Vastness Of Emotions

“A neurotic is a man who builds a castle in the air. A psychotic is the man who lives in it. A psychiatrist is the man who collects the rent.”-Jerome Lawrence

“Doubt is to certainty as neurosis is to psychosis. The neurotic is in doubt and has fears about persons and things; the psychotic has convictions and makes claims about them. In short, the neurotic has problems, the psychotic has solutions.”-Thomas Szasz

“When I believe, I am out of control. When I don’t believe, I suffer psychotic depression.”-Philip K. Dick

“What is dreaming, and what happens, and are there any real benefits to dreaming? Well, to take a step back, I think it’s important to note that dreaming essentially is a time when we all become flagrantly psychotic.”–Matthew Walker