Some people who have severe depression may also experience hallucinations and delusional thinking, the symptoms of psychosis.
Depression with psychosis is known as psychotic depression.
Symptoms of depression
Someone with depression feels sad and hopeless for most of the day, practically every day, and has no interest in anything. Getting through the day feels almost impossible.
Other typical symptoms of depression may include:
- fatigue (exhaustion)
- disturbed sleep
- changes in appetite
- feeling worthless and guilty
- being unable to concentrate or being indecisive
- thoughts of death or suicide
Doctors describe depression as mild, moderate or severe depending on your symptoms, how long it lasts and how much it affects your daily life.
Symptoms of psychosis
Having moments of psychosis (when people lose some contact with reality) means experiencing:
- delusions – thoughts or beliefs that are unlikely to be true
- hallucinations – hearing and, in some cases, feeling, smelling, seeing or tasting things that are not there; hearing voices is a common hallucination
The delusions and hallucinations almost always reflect the person's deeply depressed mood – for example, they may become convinced they're to blame for something, or that they've committed a crime.
"Psychomotor agitation" is also common. This means not being able to relax or sit still, and constantly fidgeting.
At the other extreme, a person with psychotic depression may have "psychomotor retardation", where both their thoughts and physical movements slow down.
People with psychotic depression have an increased risk of thinking about suicide.
What causes psychotic depression?
The cause of psychotic depression is not fully understood. It's known that there's no single cause of depression and it has many different triggers.
Genes probably play a part, as severe depression can run in families.
Life events and personal circumstances can be the cause for some people. This can include bereavement, relationship problems, financial problems, health problems and recent or past traumatic experiences.
It's not known why some people with severe depression also develop psychosis.
Treating psychotic depression
Treatment for psychotic depression involves:
- medicine – a combination of antipsychotics and antidepressants can help relieve the symptoms of psychosis
- talking therapies – the 1-to-1 talking therapy cognitive behavioural therapy (CBT) has proved effective in helping some people with severe depression, including those with psychosis
- social support – support with social needs, such as education, employment or accommodation
The person may need to stay in hospital for a short period of time while they're receiving treatment.
Electroconvulsive therapy (ECT) may sometimes be recommended if the person has severe depression and other treatments, including antidepressants, have not worked. The mental health charity Mind has more information on ECT.
Treatment is usually effective, but follow-up appointments so that the person can be closely monitored are usually required.
Getting help for others
People with psychosis are often unaware that they're thinking and acting strangely.
As a result of this lack of insight, it's often down to the person's friends, relatives or carers to seek help for them.
If you're concerned about someone and think they may have psychosis, you could contact their social worker or mental health team if they've previously been diagnosed with a mental health condition.
Contact the person's GP if this is the first time they've shown symptoms of psychosis.
If you think the person's symptoms are placing them or others at possible risk of harm you can:
- take them to your nearest accident and emergency (A&E) department, if they agree
- call a GP or use an NHS urgent and emergency care service
- call 999 to ask for an ambulance
The following websites provide further information and support:
If you've been diagnosed with psychotic depression, it's your legal obligation to tell the Driver & Vehicle Licensing Agency (DVLA).
You must not drive until you have been assessed as safe to do so.