Maintenance Drug Treatment for Psychotic Depression

by Brooke Nichols

Overview

Psychotic depression is the common name for diagnosis of major depressive disorder, severe with psychotic features. This condition includes symptoms of major depression in addition to symptoms of psychosis such as auditory or visual hallucinations. Thorough evaluation by a mental health professional is necessary to determine a diagnosis of psychotic depression. Psychotic depression can cause significant risk to patients if left untreated.

Psychotic Depression
Evaluation

Seeking evaluation for a patient experiencing psychotic depression is the first step in establishing a plan for treatment. Patients who present a chronically sad mood, loss of pleasure, excessive guilt, lack of energy, sleep disturbance, appetite/weight changes and/or suicidal thoughts are considered to be depressed. Psychotic depression would include additional symptoms such as severe paranoia and auditory or visual hallucinations.

Treatment Options

Recommending a psychiatrist for psychotic depression is optimal as the symptoms can be severe and this type of physician will specialize in treating the disorder. Psychotic symptoms can impair functioning to the level that inpatient treatment is necessary. Typically, someone with psychotic depression will be given a psychotropic medication such as haloperidol, risperidone or ziprazidone immediately to relieve psychotic symptoms such as auditory or visual hallucinations.
Medications

Medicating psychotic depression is the best option to resolve symptoms. Medications for maintenance long-term use to control psychotic depression may include antidepressants, mood stabilizers and/or antipsychotic medication. Individuals respond to medications differently and some trial and error with different medications may be necessary to maximize benefit in treatment. A combination of medications may be very beneficial in controlling symptoms of psychosis and depression. If psychotic depression does not respond to medication, electroconvulsive therapy (ECT) may be considered (see resource).

Overview