Psychotic depression is a serious medical illness characterized by a simultaneous disturbance of mood (major depression) and thought (psychosis). The depressive component is profound and seriously influences the patient's mental and physical states. The psychotic elements manifest as disturbances of thought and perception. Psychotic depression is thought to be a distinct illness.
The symptoms of psychotic major depression include:
Depressive symptoms, which persist over a period of time and involve:
- Feeling sad, empty, worthless, hopeless, helpless, guilty
- Diminished energy, interest and pleasure
- Changes in appetite, sleep, energy and concentration
- Thoughts of death and/or suicide
Psychotic symptoms:
- Delusions
- Hallucinations – typically auditory (hearing voices)
These delusions and hallucinations generally reflect a person's state of mind. As such, the individual may hear denigrating voices, or may believe that others are talking disparagingly about him/her. Delusional themes tend to involve paranoia or severe physical complaints.
The cause of psychotic major depression is unknown. It is also unclear why only a percentage of individuals with major depression have psychotic features. There is, however, a theory developed by Dr. Alan Schatzberg, a co-founder of Corcept and the Chairman of the Department of Psychiatry at Stanford University and others, which suggests that individuals with psychotic depression have both elevated levels and disordered patterns of cortisol, a hormone produced by the adrenal gland that plays a significant role in the way the body reacts to stressful conditions.
The course of psychotic major depression is such that patients with it often require hospitalization. As a result, the disease produces substantial emotional and financial costs. In addition, psychotically depressed individuals are at increased risk for suicide. Almost 15 percent of those suffering from severe depression ultimately commit suicide. Every year, 10 to 20 million people worldwide attempt suicide … and one million end up killing themselves. Individuals with psychotic major depression are at least 70 times more likely to commit suicide in their lifetime than the general population. In fact, individuals with psychotic depression appear to be five times more likely to commit suicide than those suffering from major depression without psychotic features.
In the United States, major depression ranks second only to ischemic heart disease as a leading cause of disease burden. 19 million American adults suffer from depressive disorders each year.
About 15 to 20 percent
of depressed patients (or about 3 million people) have psychotic major
depression (PMD). While there are no confirmed data on the costs associated
with psychotic depression, it is widely assumed that, on average, it is
more costly than depression without psychotic symptoms. What is known
is that clinical depression has become one of America's biggest health
burdens and the enormous cost in human suffering and disruption of personal,
family and work life is formidable. According to the National Mental Health
Association, major depression costs the nation about $44 billion in lost
work days (more than 200 million days a year), lost productivity and direct
treatment costs. Depressive illnesses cause pain not only to those who
have the disorder, but also to the individuals who care about them.
