Psychotic major depression (PMD) is a type of depression that can include
symptoms and treatments that are different from those of non-psychotic
major depressive disorder (NPMD). PMD is estimated to affect about 0.4% of the population (or one in every 250 people). Many people with psychotic depression experience delusions, which are beliefs or feelings that are untrue or unsupported. PMD is sometimes mistaken for NPMD,
schizoaffective disorder,
schizophrenia and/or other psychotic disorders.
Bipolar patients may experience PMD during depressed states. PMD is usually episodic, lasting for a defined amount of time, but in some cases can be chronic. PMD has unique biological features, which have led to innovative treatments. While PMD is often treated with a combination of antidepressants and antipsychotics, researchers have been developing new treatments that address the pathophysiology of PMD more directly.
Currently, PMD is considered a severe form of major depression, but patients with mild or moderate depression may still have psychotic features. Many people with PMD experience delusions, which are beliefs or feelings that are untrue or unsupported. Paranoid delusions or delusions of guilt may be the most common psychotic symptoms in PMD. Patients with PMD often have concerns that people are paying special attention to them or are trying to persecute them. Patients who experience delusional guilt may believe that they are being punished for past misdeeds or are responsible for problems they couldn’t possibly be responsible for.
Other common delusions include those in which people are concerned that something is terribly wrong with their bodies and physical health, when actually there isn’t anything wrong. Unlike other psychotic disorders, the delusions in PMD may not be very obvious. Delusions appear to be more common than hallucinations in PMD, but some people with PMD do hallucinate, or see or hear things that others do not. Auditory hallucinations (sounds) are perhaps the most common hallucinations seen in PMD. While other patients may report seeing, touching or smelling things that are not there, it is less common.
Other symptoms that are common in PMD are agitation, difficulty falling asleep, and frequent waking during the night. In addition, patients with PMD may have a greater suicide risk than patients with NPMD. Finally, those with PMD may have greater cognitive deficits (e.g., memory problems) than those with NPMD.
