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Psychotic depression - Clinical depression

If you have severe clinical depression you may also experience hallucinations and delusional thinking. These are the symptoms of psychosis.

Depression with psychosis is called psychotic depression.

Symptoms of severe depression

If you have clinical depression, you will feel sad and hopeless for most of the day. You will feel like this most days and you will have no interest in anything. Getting through the day feels almost impossible.

Other typical symptoms of severe depression are:

  • fatigue (exhaustion)
  • loss of pleasure in things
  • disturbed sleep
  • changes in appetite
  • feeling worthless and guilty
  • being unable to concentrate or being indecisive
  • thoughts of death or suicide

Symptoms of psychosis

Moments of psychosis (psychotic episodes) means having:

  • delusions – thoughts or beliefs that are unlikely to be true
  • hallucinations – hearing, feeling, smelling, seeing or tasting things that are not there

The delusions and hallucinations almost always reflect a depressed mood. For example, you may become convinced you're to blame for something or that you've committed a crime.

Psychomotor agitation is also common. This means not being able to relax or sit still and constantly fidgeting.

If you have psychotic depression, you may also have psychomotor retardation. This is when your thoughts and physical movements slow down.

People with psychotic depression have an increased risk of thinking about suicide.

Causes of psychotic depression

The cause of psychotic depression is not fully understood. There's no single cause of depression and it has many different triggers.

For some, it can be as a result of stressful life events.

For example:

  • bereavement
  • divorce
  • serious illness
  • financial worries

Genes probably play a part. Severe depression can run in families. But it is not known why some people also develop psychosis.

Many people with psychotic depression had a traumatic event in childhood.

Treating psychotic depression

Treatment for psychotic depression involves:

You may need to stay in hospital for a short time while you are getting treatment.

Electroconvulsive therapy (ECT) is sometimes used if all other treatments have not worked.

Content supplied by the NHS and adapted for Ireland by the HSE

Page last reviewed: 1 September 2022
Next review due: 1 September 2025