Written by: THE BALANCE
Medically reviewed by Dr. Sarah Boss, MD
Last updated: January 20, 2026
Fact checked
Quick Summary
  • The major depressive disorder affects more than 16 million people across the world.
  • Of this, many adults develop symptoms like hallucinations and delusions, paving the way for psychotic depression and even more serious and deadly psychiatric disorders.
  • What makes this type of depression much more severe is that if the psychotic symptoms associated with it rise to the level of a medical emergency, the sufferer may attempt to harm themselves or some around them.
Reading time: 9 min

The major depressive disorder affects more than 16 million people across the world. Of this, many adults develop symptoms like hallucinations and delusions, paving the way for psychotic depression and even more serious and deadly psychiatric disorders.

What makes this type of depression much more severe is that if the psychotic symptoms associated with it rise to the level of a medical emergency, the sufferer may attempt to harm themselves or some around them. Despite being a grave medical disorder, psychotic depression responds well to long-term rehab programmes offering combinations of therapies and medication.

As the name indicates, psychotic depression is a psychiatric illness characterised by feelings of sadness, guilt, and social isolation together with more serious symptoms of delusions and hallucinations. This issue can break a person from reality and make it difficult for them to continue normally with life.

The symptoms of psychotic depression usually begin with the standard indicators of a major depressive disorder, such as:

Loss of energy and motivation

Even the simplest tasks can become extremely difficult to complete for someone with depression because of low motivation and energy levels.

Sleep disruptions

Deterioration of sleeping habits is another characteristic symptom of depression.  An individual battling it may find it difficult to sleep and consequently take longer naps at odd hours during the day.

Poor cognitive performance

Depression can make it difficult for people to concentrate and recall memories. Most of them also struggle to make decisions and are mostly disengaged from the current life events going on around them.

Physical distress

Depression is commonly associated with a deterioration of physical health. This deterioration manifests in symptoms like digestive problems, headaches, chest pain, shortness of breath, and more.

Loss of interest in pleasurable activities

Depression can make a person lose interest in their favorite hobbies and activities by robbing them of their capacity to feel delighted, joy, and a sense of achievement.

Hopelessness

When people develop depression, their optimism and outlook on general life diminish to a flicker. It can make them feel lost without any hope for a better time.

As an episode of depression deepens, the vulnerability to developing psychosis gradually increases. Finally, when the level of depression is high enough, symptoms such as the following occur:

  • Anxiety
  • Panic attacks
  • Illogical actions or speech
  • Hostile responses
  • Intellectual impairment
  • Frequent complaints of ill health
  • Physical immobility
  • Irritability
  • Paranoia
  • Restlessness and agitation

Finally, as psychosis begins, hallucinations and delusions develop that trigger significant interference in daily life and call for rapid medical intervention.

People who suffer from a major depressive disorder with psychotic symptoms may not be in a position to seek help on their own. They have a loss of motivation and experience deep pessimism that may render them incapable of imagining a good life. When the psychotic symptoms set in, the problem becomes even worse as these individuals struggle to perceive the world as well as themselves correctly. It is possible that they may no longer realise the need to ask for help as they lose themselves in the shadows of their confused minds.

In such circumstances, the family members and caregivers of such individuals must take swift action. Your loved one can respond positively to hospitalisation and mental health treatment, no matter when it is sought. However, recovery becomes less complicated if it involves immediate professional assistance before their psychosis becomes worse.

Starting treatment early, staying on the path of recovery, and closely cooperating with the medical and psychological teams can all have a good impact on recovery. Major depression with psychotic features, in particular, is a combination of mental health disorders that demand early and persistent care delivered by experts as the patients are at a considerable risk of self-harm and suicide. However, the psychotic and depressive symptoms can be managed with adequate treatment.

The two most common treatment modalities used to manage psychotic depression in rehab include:

Medication

While there is no specific medication to treat psychotic depression, a combination of antipsychotics and antidepressants is mainly prescribed and has been associated with high success rates. However, medication management in such clients has to be handled extremely carefully, and experts must determine the most appropriate prescriptions and dosages.

Medications are considered the primary approach to psychotic depression treatment; however, some clients may resist it. For such patients, a combination of other therapies is usually offered.

Psychotherapy

Individual therapy is commonly offered at rehabs to make clients become more aware of their problems and understand how their psychotic and depressive symptoms are affected them. In doing so, they can escape from the control of these symptoms and dedicate themselves to recovery.

Along with suitable medication, psychotherapy, in the form of individual, family, and group sessions, is offered to support clients as they strive toward long-term recoveries. It also helps them stay on track with their proposed treatment plans.

Because psychotic depression is usually associated with self-harm and suicidal tendencies as well as substance addiction, clients with this diagnosis are usually suggested to undertake inpatient treatment programmes. In such programmes, they live on-campus under 24/7 medical surveillance as different experts strive to control their symptoms and provide rehabilitation services.

Another benefit of seeking residential treatment is the opportunity to receive holistic support for better symptom management and long-term support for recovery. These holistic approaches empower clients to search for solutions to their distressing issues and anticipate living a life they have always dreamed of.

Most rehabs in the UK encourage involving families in therapy for sustainable healing from psychotic depression and other types of mental health disorders. This participation in the treatment and recovery process can be offered in the following ways:

Family Therapy

In addition to individual and group therapy, many psychotic depression treatment plans make use of family therapy to support recovery. During these uplifting and stimulating sessions, clients’ families are provided with a chance to support their loved ones’ recovery by offering unconditional love and empathy. The therapy also focuses on the resolution of family conflicts, if any, as they might act as a trigger to depression.

Educational Groups

Some rehabs arrange educational group meetings, either in person or virtually, that involve clients and their families. The purpose of these meetings is to help the family members educate themselves about psychotic depression so that they can help their loved ones in a better way.

Multi-Family Support Groups

These support groups connect families of different clients to share the issues they are facing and find support. These enlightening sessions help families connect with empathetic peers with important insights that may potentially help them bond with their loved ones and support them in their healing process.

If you are concerned about a loved one and have a reason to believe that they require residential care for psychotic depression, we can help. At our rehab center in the UK, we offer long-term treatment programmes for people with complex mental health issues such as depression with psychosis and management of other co-occurring disorders. Our approach to recovery is inclusive and compassionate. Working together, we’ll help formulate a healing team comprising experts and empathetic supporters who will inspire and motivate your loved one for a better life.

Contact us now to learn more about our treatment program and how we can help you and your dear one begin the journey to recovery today.

FAQs

What is the difference between psychotic depression and schizophrenia?
People with psychotic depression and schizophrenia both undergo psychosis. However, psychosis in the former is associated with the primary condition of depression, a mood disorder. Hence, this psychosis is often accompanied by feelings of failure, sadness, and a negative self-image. More importantly, this type of psychosis only occurs during an active episode of major depression. People with psychotic depression are able to appreciate their symptoms, may develop shame, and try to conceal their problems from others.
On the other hand, psychosis associated with schizophrenia is often combined with other symptoms, like delusions, disrupted thought processes, and hallucinations. These symptoms occur independent of their mood status and are often implausible.
Am I at risk of developing psychotic depression?
In general, depression occurs as a result of chemical and hormonal imbalances in the brain. Sometimes, certain inherited traits and negative life consequences also trigger depression. Factors associated with psychotic depression include low self-esteem, self-loathing, and holding a pessimistic view of the world. Additionally, any traumatic life events can also trigger its episodes, such as:
Loss of a job
History of sexual or physical abuse
Problems with personal relationships or finances
Do I need treatment for psychotic depression?
The experience of psychotic depression can generally vary from one person to another, making it difficult for someone to establish at what point they require treatment. However, if you answer yes to the following questions, a psychotic depression recovery center will most likely help you.
Do you often feel like someone or something has possessed you?
Do you believe that people around you can communicate with each other through telepathy?
Do you ever feel like all things on the TV or in a magazine have been written especially for you?
Have you ever had vivid thoughts that you believe others can hear?
What are different therapy formats offered to treat severe depression with psychosis?
Severe cases of psychotic depression are managed through rigorous therapy and counseling sessions that take place in the following formats:
One-on-one therapy where you are alone with a therapist.
Group therapy takes place in the presence of a therapist and other people with similar issues as you.
Family therapy, that involves your family members to strengthen their relationships with you and support recovery.

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