Psychotic Depression Treatment. There is MORE than just medications!!! Treatment of psychotic depression involves three approaches.
In a previous video, I talked about the symptoms and causes of psychotic depression. Today, I'll be talking about the treatment of psychotic depression. This condition is a severe mental disorder that manifests with depressive symptoms as well as psychosis. Psychosis can be delusions or hallucinations. In most cases, psychotic depression presents with delusions, not hallucinations.
An example would be someone who experiences depressive symptoms such as low mood, decreased appetite, weight loss, difficulty sleeping, fatigue, and feelings of worthlessness. In addition to these symptoms, such a person may experience the delusional belief that eating any food would cause the decay of body organs.
Such a presentation can cause functional impairment - meaning the person struggles with work, school, social interactions, and personal relationships. Psychosis can be frightening and distressing not only to the person suffering from it but also to people around them.
Experts usually classify psychotic depression as Major depressive disorder with mood-congruent psychotic features or Major depressive disorder with mood-incongruent psychotic features. I also discussed the differences in a previous video.
Depending on the severity of psychotic depression, treatment can be inpatient or outpatient. Inpatient treatment involves admitting the person to a psychiatric hospital for intensive treatment. This is necessary when the symptoms are very severe, or there is a risk of harm to oneself or others.
Outpatient treatment means the person is not admitted to a hospital. Instead, treatment involves an outpatient clinic, Intensive outpatient program, or partial hospitalization program. In these programs, the person sees a mental health practitioner and goes back home after treatment.
In general, there are three approaches to treatment. Biological, psychological, and social treatments. This combination is sometimes referred to as a biopsychosocial approach.
The biological approach involves medications. This is the primary treatment for psychotic depression. It requires a combination of antidepressants and antipsychotic medications.
Antidepressants help to relieve the symptoms of depression. Some examples of antidepressants are Lexapro, Effexor, and Trintellix. Newer treatment options like esketamine or Spravato and transcranial magnetic stimulation or TMS are also helpful in treating depression.
Antipsychotics help to manage the psychotic symptoms - which could be hallucinations, but usually delusions. Examples of antipsychotics are aripiprazole, risperidone, and quetiapine. These are newer or atypical antipsychotics, and these are used more commonly than the older antipsychotics as they have fewer side effects.
The second approach is psychotherapy. Also known as talk therapy or counseling, psychotherapy can be an effective part of the treatment plan. Cognitive-behavioral therapy (CBT) and other forms of therapy can help you understand and manage your condition.
The third approach is Social support. Life stressors such as loss of employment, financial issues, relationship difficulties, and problems with school can precipitate or aggravate psychotic depression. It is essential to offer support in these various areas to help with stability. Assistance with education, employment, or accommodation can go a long way in relieving stress. Joining support groups and connecting with family and friends can help with overall wellness.
When it comes to medications, one question many people ask me is how long they have to be on medications. The duration depends on several factors, including the severity of the symptoms, the individual's response to the medication, and side effects. It also depends on whether this is the first time you are taking medications for depression.
When first diagnosed with psychotic depression, the initial treatment phase focuses on reducing the acute psychotic symptoms - hallucinations and delusions. Treatment also commences for the depressive symptoms.
Once the acute symptoms are under control, the maintenance phase begins. The goal of this phase is to prevent the symptoms from recurring.
After a period of stability, the healthcare provider may evaluate the possibility of gradually tapering and discontinuing medications.
