When Strange Beliefs Accompany Depression


A depressed mood, lack of motivation, fatigue, and feeling hopeless are familiar symptoms of depression. Although it is somewhat rare, depressed individuals may also experience psychosis.

Psychosis is a disturbance of contact with the everyday reality most people experience. Psychotic symptoms include hallucinations - hearing or seeing things others do not - or holding ideas and beliefs that are clearly false, called delusions.

The psychotic symptoms can be anywhere from mild and transitory to persistent and severe. Besides hallucinations and delusions, symptoms include confused thought processing.

Professionals call this mix of depressed and psychotic symptoms either psychotic depression, major depression with psychosis, or depression with psychotic features.

The Symptoms

The hallucinations and delusions of depressed individuals are typically voices, visions, or beliefs related to being bad, worthless, ill, or evil, and might prompt a person to harm their self. Having these symptoms also increases anxiety, and makes sleeping and concentration extremely difficult.

An example of a delusion is believing that you will get sick if you wash your hair, or that your house is bugged by a secret agency. A hallucination might be hearing a voice - distinct from your own thoughts - telling you that you are worthless and deserve to be alone.

Although psychotic symptoms can be frightening, and for some people embarrassing, it is best to inform your doctor immediately if you or a family member experience them. These symptoms can be triggered by physical conditions or medications, and your doctor will want to rule out those possibilities.

Usually in depression with psychosis, the depressed person is aware that the psychotic symptoms are not real, although they are experienced as real and negatively affect everyday functioning. This awareness distinguishes psychotic depression from schizophrenia where individuals believe their delusions and hallucinations are real.


A vulnerability to depression with psychosis may run in families, but its cause is unknown. The conventional treatment is psychotherapy combined with antidepressant medication, and sometimes the addition of an antipsychotic medication. When symptoms are stubborn and severe, electro-convulsive or shock therapy may be recommended.

The greatest risk with psychotic depression is the potential for suicide, so getting help quickly is recommended. Although it can take weeks or months, people do recover from psychotic depression.

Photo credit: akshay moon (@flickr)


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