Psychotic Depression Treatment
Written by: THE BALANCE
Medically reviewed by Dr. Sarah Boss, MD
Last updated: January 19, 2026
Fact checked
Quick Summary
  • When somebody has both depression and psychosis, they are said to have depression with psychotic characteristics.
  • Psychosis is characterized by a dissociation from reality, which might manifest as delusions and hallucinations.
  • Psychotic depression is a term used to describe major depression with psychotic symptoms.
Reading time: 8 min

When somebody has both depression and psychosis, they are said to have depression with psychotic characteristics. Psychosis is characterized by a dissociation from reality, which might manifest as delusions and hallucinations.

Psychotic depression is a term used to describe major depression with psychotic symptoms. It’s a serious condition marked by a mix of unipolar major depression symptoms and psychosis.

According to some estimates, 14.7 to 18.5% of patients with serious depression may have psychotic symptoms, and the prevalence estimates may increase with age.

This type of depression is frequently misdiagnosed and untreated. Because we’re talking about unipolar depression, significant depression pertains to a major depressive episode rather than bipolar disorder.

In the US, major depression is among the most frequent mental illnesses. As per the National Institute of Mental Health (NIMH), at least one major depressive episode was experienced by 4.3% of individuals in the US in 2016. (source: NIMH, 2024)

This article will go over how doctors identify and treat psychosis with depression, as well as therapy choices and recovery plans.

Psychotic depression is defined as a major depressive disorder with psychotic features, which is a subtype of depression. It includes psychotic symptoms happening during a depressive episode.

Psychosis can manifest itself in a variety of ways, including:

  • Delusions
  • Hallucinations
  • Deterioration of the mind and body
  • A state of semi-consciousness or stupor

According to statistics based on population samples, MDD with psychosis impacts anywhere from 10 percent to 19 percent of patients experiencing a major depressive episode. Among individuals getting inpatient treatment for depression, this rate rises to: (source: NIMH, 2024 (MDD))

  • In between 25 and 45% of adults
  • Up to 53% of senior citizens

Because clinicians don’t always notice psychosis while diagnosing depression, some scientists agree MDD with psychosis occurs at higher rates.

In fact, according to a 2008 study based on data from four separate medical institutes, professionals misidentified this disease 27% of the time.

MDD, also known as clinical depression, can have a negative impact on your emotions, behavior, daily life, and physical wellbeing.

Typical symptoms of a major depressive episode include: (source: APA, 2024 (DSM-5-TR))

  • During at least 2 weeks, a sustained low mood or lack of interest in normal life
  • Four or more  other depressive symptoms 

Psychosis is not listed among the nine major symptoms of depression, and many people with MDD never encounter it.

The most recent edition of the “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)” separates the two, designating depression with specific features as a separate diagnosis. “Other Specified Depressive Disorder” is a term used to describe psychosis.

Depression is a major mental health condition. Nonetheless, experts regard MDD with psychosis to be more severe than depression without psychosis since it is more probably to include:

  • Features of depression
  • More serious signs and symptoms
  • An increased risk of self-harm or suicidal tendencies

You will experience symptoms of both psychosis and major depression if you have MDD with psychosis. (source: MedlinePlus, 2024 (Psychosis))

The following are some of the signs and symptoms of serious depression:

  • A dismal, empty, sorrowful, or hopeless emotion that persists (some people may think life is not worth a shot or worthy of living, and others might feel more irritated than sad)
  • Losing interest and pleasure in previously enjoyed activities
  • Unexpected or unexplainable weight and change in appetite
  • Sleeping problems, such as sleeping a lot more or a lot less than usual
  • A lack of energy or lasting weariness
  • Alterations in movement, such as restlessness or a feeling of being slowed down
  • Having trouble focusing or making judgments
  • Sentiments of worthlessness, powerlessness, self-hatred, or shame on a regular basis
  • Thinking of death, suicide, or dying on a regular basis

Psychosis is characterized by a breach or separation from reality. As a result, those who are affected aren’t always mindful of their symptoms, which include:

  • Hallucinations are when you hear, see or feel things that aren’t real.
  • Delusions are when people believe things that never happened.
  • Slowed thinking, actions, and feelings are known as psychomotor impairment.
  • A state of unconsciousness in which you are unable to move, speak or respond to your surroundings
  • The following are examples of psychotic hallucinations and delusions:
  • Despite repeated tests indicating otherwise, believing you have a major health problem
  • Believing that you have special abilities
  • Imagining yourself to be a renowned or significant person
  • Hearing people insulting or condemning you
  • Being pursued by a terrifying or dangerous animal
  • Paranoia, or illogical or excessive fear of others

Delusions, with or without hallucinations, are more common in patients suffering from psychosis with depression than psychotic episodes alone.

Experts divide MDD with psychotic symptoms into two categories:

MDD with psychotic symptoms that are mood-congruent. Sentiments of personal inadequacies, unworthiness, guilt, anxiety, worry, or dread of disease or death are common in depression, and delusions and hallucinations reflect these feelings and emotions. (source: NICE, 2022)

MDD with psychotic characteristics that are mood-incongruent. Depression-related emotions clash with delusions and hallucinations. You could see a dear one,  hear voices and crowds praising you, or smell something delicious. You might also suspect that someone is pursuing you, attempting to kidnap you, or attempting to manipulate your thoughts.

Mood-congruent and mood-incongruent signs are also possible to occur at the same time.  Experts previously linked psychosis’ mood-incongruent traits to poorer results. According to new research, this isn’t always the case.

Hallucinations and delusions can appear to be real. They can cause anxiety, panic, and a great deal of distress. In an attempt to prevent the symptoms, some people suffering from psychosis harm themselves or others. That is why it is critical to seek care for psychosis as soon as possible.

If you’re suffering from both psychosis and depression, seek help from a mental health practitioner right immediately. Without proper therapy, this health problem is unlikely to improve. (source: NICE, 2016 (Psychosis))

To effectively treat psychosis and recurrent thoughts of self-harm or suicide, your medical team may prescribe a brief stay in a mental hospital.

Psychotropic medicines are commonly used to treat psychotic depression, but there are alternative possibilities as well.

Therapy

While therapy may not be sufficient to alleviate psychosis symptoms on its own, it can be helpful as a supplement. (source: StatPearls, 2025)

For one thing, therapy provides a safe environment in which to express troubling emotions and experiences. A therapist can also teach you how to deal with delusions and hallucinations.

Approaches that could be used include:

  • Cognitive behavior therapy (CBT)
  • Therapy based on acceptance and commitment
  • Behavioral activation
  • Acceptance-based psychotherapy for psychosis and depression

Electroconvulsive therapy (ECT)

If you have severe depression that isn’t responding to medicine or counseling, your doctor may consider ECT. (source: SAMHSA, 2024)

ECT is usually administered in a hospital setting while you are sedated. This treatment comprises a series of treatments that use a calibrated voltage of electrical charge to stimulate your brain. The current causes a small seizure, which alters neurotransmitter levels in the brain.

While ECT is generally safe and helpful for patients who are having suicidal thoughts, psychosis, or catatonia, it does come with a few hazards, including:

  • Loss of memory in the short term
  • Sickness or nausea
  • Headache
  • Fatigue

Before you start treatment, your healthcare team will go over these risks in further detail with you.

Because ECT may not completely prevent recurrence of symptoms, your psychiatrist will probably recommend further treatment in the form of counseling, medication, or both. They might also suggest that you get ECT in the future. (source: Cochrane, 2020)

Medication

Typically, antipsychotics and antidepressants are used in conjunction to treat depression and psychosis. These drugs help the brain’s neurotransmitters to be balanced.

A selective serotonin reuptake inhibitor (SSRI) and one of the following antipsychotics might well be prescribed by your doctor or psychiatrist, for instance:

  • Olanzapine is a drug that is used to treat symptoms of psychotic conditions
  • Quetiapine is a medication used to treat depression
  • Risperidone is a drug that is used to treat schizophrenia

They can also give you additional information about drug options and assist you. Find the proper drug and dosage, as well as provide information on potential side effects. These medicines can start working immediately, but the full results may take several weeks to see.

FAQs

Is Psychotic Depression Treatment Always Effective?
Psychotic depression treatment is quite successful. People are frequently able to salvage and recover within a few months. However, medical monitoring may be required in the future. If medication fails to relieve psychosis and depression, electroconvulsive treatment (ECT) may be employed. It’s critical for patients to collaborate with their doctors in order to locate the best effective drugs with the fewest adverse effects. Since psychotic depression is so severe, there is a high risk of suicide.
Is Depression A Psychotic Disorder
Psychotic features are also listed as a subcategory of major depression in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In the DSM-5, however, psychotic characteristics are not indicative of the extent of severe depression.
Depression with psychotic symptoms can be misdiagnosed as other diseases by healthcare providers. Other illnesses that may be present include:
Major depressive illness with no psychotic symptoms
Schizoaffective disorder
Not otherwise specified depression
Mood disorder
Misdiagnosis is frequently caused by a failure to recognize the psychotic symptoms of serious depression. If somebody has psychotic depression, it must be determined by a qualified mental health practitioner.

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