Recognize and treat psychotic depression

Depression is one of the most common mental illnesses worldwide. Almost everyone has come into direct or indirect contact with this disorder. Accordingly, the classic symptoms such as listlessness, dejection, feelings of worthlessness and, in severe cases, suicidal tendencies are familiar. It is less well known that there is depression in which delusional symptoms, also called psychotic symptoms, occur in addition to the depressive symptoms. This disorder pattern of psychotic depression is rarer, yet education about it is just as necessary as education about “classic” depression.

Delusional or psychotic depression

Depression progresses in phases, which is why experts refer to it as depressive episodes. In a depressive episode, both the symptoms and the severity can vary. One speaks of mild, moderate or severe depressive episodes. Delusional symptoms occur primarily in connection with severe depressive episodes.

Symptoms of psychotic depression

In psychotic depression, the disturbance pattern of delusion occurs in addition to the familiar symptoms. Delusion means that the affected person becomes mentally involved in a story that relates to a specific topic. The affected persons are mentally completely fixed on this one topic and can only detach themselves from it with difficulty. The following delusions or delusional stories are common:

  • Delusion of indebtedness: This delusion is also called impoverishment delusion and includes the firm conviction that the affected person will sooner or later inevitably be financially ruined.
  • Delusion of sin: This delusion is also called delusion of guilt. Sufferers are convinced that they have sinned or are to blame for events (for example, crimes or their own illness). This is often accompanied by the fact that the disease is seen as a kind of punishment for one’s own guilt.
  • Delusion of diminishment: This delusion can mean in the literal sense that the person is of the firm view to shrink more and more and eventually into nothingness. However, it can also be metaphorical for the fact that people with this delusion assume that their existence is void and that their feelings and experiences are completely insignificant.

Affected people usually can not or only with difficulty recognize that their delusion does not correspond to reality. This characteristic of delusions is also typical of other mental disorders associated with delusions, such as schizophrenia or dementia.

Causes of psychotic depression

Like most mental disorders, psychotic depression cannot be explained by a single cause. Rather, different factors interact. On the one hand, personality traits, past experiences, and psychological functioning all play a role. On the other hand, depression leads to an imbalance of messenger substances in the brain, for example serotonin, noradrenaline and dopamine. This alters drive, mood and also perception. Dopamine in particular seems to play an important role in perception. There is evidence that in psychotic depression there is an imbalance in the dopamine balance and thus perception is severely impaired.

Psychotic Depression and Altered Perception

Psychotic depression leads to severely altered perception. The result is that reality and perception no longer match. In technical language, this is called “cognitive distortions”. If these cognitive distortions are extremely pronounced, a delusion develops. Individual impressions are then overvalued or undervalued, thus pushing themselves more or less into consciousness. Things that are not actually related to each other are put in relation to each other. For example, the disease depression is attributed solely to the idea that the person with the disease must atone for a deed. The reality of depression is that biological, personal and psychological factors are interdependent.

Treatment of psychotic depression

Initially, the same treatment guidelines apply to psychotic depression as to depression without psychotic symptoms. However, people suffering from psychotic depression may find it more difficult to seek treatment at all. This is due to severe misinterpretation of reality. Here, compassionate support and low-threshold help is needed so that those affected can receive the appropriate treatment.

Psychotherapeutic and drug help for psychotic depression

Affected persons are stabilized with the help of various therapy components. These primarily include conversational psychotherapy and, if necessary, medication. Helpful medications can be, on the one hand, classic antidepressants. On the other hand, it may be necessary to use sedative or anti-anxiety medications. This is because: a delusion can put the affected person under severe anxiety and intense stress. It is very stressful to suffer from a delusion, because it shakes the entire world view.

Further therapy components for psychotic depression

In addition, there are sports, nutrition and complementary therapies such as mindfulness training, physiotherapy and occupational therapy. As the acute symptoms are relieved, the delusional content usually improves as well. However, these are also directly addressed and worked on in psychotherapy. In the case of psychotic depression, those affected and their relatives should also be informed about the disorder in order to be able to classify their experiences.

Recognize and treat psychotic depression quickly

Fortunately, psychotic depression, like classic depression, is also easily treatable. However, it is also important here that treatment begins as soon as possible, so that the symptoms do not become chronic. Those affected and their relatives should also make sure that treatment is carried out according to scientific guidelines and that those treating them have the necessary expertise. These prerequisites make the Limes Schlosskliniken an optimal partner for the treatment of psychotic depression! Scientific foundation, expertise and holistic recovery are emphasized here.


Hautzinger, M. (2011). Depression. In Behavioral therapy manual (pp. 565-571). Springer, Berlin, Heidelberg.

Categories: Depression

Verena Klein
Autor Verena Klein
"Die LIMES Schlosskliniken haben sich auf die Behandlung von psychischen und psychosomatischen Erkrankungen spezialisiert. Mit Hilfe des Blogs möchten wir als Klinikgruppe die verschiedenen psychischen Erkrankungen näher beleuchten und verschiedene Therapien sowie aktuelle Themen vorstellen."

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