Frequently asked Qs

• What are the key facts?
  • Psychotic depression is a mental illness. It is when you experience moderate or severe symptoms of depression but also symptoms of psychosis too.
  • A number of risk factors might play a part in the development of psychotic depression.
  • A psychiatrist might diagnose psychotic depression after a mental health assessment or assessments.
  • Psychotic depression is usually treated with medication, talking therapy, and social support.
  • If you think you have psychotic depression, there are options for support and treatment. This includes your local NHS early intervention in psychosis team and options for urgent help if you need it.
  • There are options for your loved ones to get support for you.
  • There are things you can do to help yourself.
• What is psychotic depression?

  Psychotic depression is a mental illness. It is when you experience moderate or severe symptoms of depression but also symptoms of psychosis too. 

  You will usually experience: 

  • symptoms of psychosis, known as delusions and hallucinations, and
  • many common symptoms of depression.

  You might find the symptoms of psychotic depression difficult to cope with. They might even lead to you having suicidal thoughts.  

  If you need urgent help see our Get help now link.  Or see What can I do if I think I have psychotic depression? below.

  You can find more information about the following things in our pages on:

  • Depression
  • Psychosis
  • Suicidal thoughts - How to cope

  What is the difference between psychotic depression and schizophrenia? 

  If you live with schizophrenia, you will experience symptoms of psychosis, usually including hallucinations and delusions. But schizophrenia is different from psychotic depression. 

  If you live with psychotic depression, you will experience other symptoms beyond hallucinations and delusions. These include depressed mood, fatigue, and suicidal ideation. 

  These depressive symptoms are usually absent in schizophrenia.

• How common is psychotic depression?

  It is hard to find accurate figures for how many people experience psychotic depression. But it appears to be is less common than schizophrenia.  

  According to the Royal College of Psychiatrists, schizophrenia affects around 1 in 100 people.   The following study says psychotic depression affects about 1 in 250 people: https://bit.ly/4hgJabm 

  Can new mothers experience psychotic depression?

  New mothers can experience psychotic depression after the birth of their baby.  

  If this happens to you while you are still in hospital, you should get the support you need from staff.

  If you or your loved one get symptoms while you are at home see What can I do if I think I have psychotic depression? below.

  For more information see our page on New parents, pregnancy, and mental health - Perinatal mental health 

• What causes psychotic depression?

  What can cause you to develop psychotic depression can be complicated. Often, there might be no single cause. 

  A number of risk factors might play a part in the development of psychotic depression. These can include: 

  • Isolation, like living on your own, or not enough contact with loved ones  
  • Past abuse or neglect, maybe as a child
  • A family history of mental illness
  • Stressful things like, relationship issues, the death of a loved one, financial or health problems, or losing your job
  • Having other mental health issues 

  You can find more information about the following things in our pages on:

  • Does mental illness run in families?
  • Social inclusion and mental illness - How can I become more connected
  • Stress - How to cope
• What are the symptoms of psychotic depression?

  If you are experiencing psychosis, you will probably be out of touch with reality. If you are living with psychotic depression, you will have moderate or severe symptoms of depression too.

  You can find out more about the symptoms of psychosis and depression in our information on: 

  • Depression
  • Psychosis

  But below is a short summary of the symptoms of depression and psychosis.

  What are the symptoms of psychosis?

  Psychosis is a term used to describe when a person interprets or perceives reality in a different way to those around them. 

  You might see or hear things that others do not. Or believe things other people do not. 

  Common symptoms of psychosis are:

  • Hallucinations
  • Delusions
  • Cognitive impairments 

  What are hallucinations?

  These are when you see, hear, smell, taste or feel things that other people do not.  For example:

  • hearing voices or sounds other people cannot, or
  • seeing things which other people do not.

  Hearing voices or other sounds is the most common type of hallucination. 

  What are delusions?

  These are unusual beliefs that other people within your community do not share, even though they feel real to you. 

  For example, you may worry:    

  • that you are being followed by secret agents or members of the public, or
  • that people are out to get you or trying to kill you. This can be strangers or people you know.

  There are different types of delusions that people experience. Like, you may think you are a very powerful person or that you are god. These kinds of thoughts are called 'delusions of grandeur.'

  What are cognitive impairments?

  Cognitive impairments are ones that relate to mental action. Such as learning, remembering and functioning.

  Some cognitive impairments associated with psychosis are:

  concentration problems, 
  memory problems,
  difficulties in understanding new information, and
  difficulty making decisions.

  What are the symptoms of depression?

  Common symptoms of depression are:

  • low mood, feeling sad, irritable, or angry
  • having less energy to do certain things
  • losing interest in activities you used to enjoy
  • reduced concentration
  • becoming tired more easily
  • disturbed sleep and losing your appetite
  • loss of self-confidence
  • feeling guilty or worthless
  • weight loss
  • thoughts and movements slowing down
  • thoughts of self-harm or suicide.
• How is psychotic depression diagnosed?

  A psychiatrist might diagnose psychotic depression after a mental health assessment. 

  You can read more about mental health assessments from the NHS here  

  It might take more than one assessment for a psychiatrist to reach a diagnosis. 

  Psychiatrists will use the following manuals to help diagnose you:

  • International Classification of Diseases (ICD-11) produced by the World Health Organisation (WHO)  
  • Diagnostic and Statistical Manual (DSM-5) produced by the American Psychiatric Association. 

  The manuals are guides which explain different mental health conditions and their symptoms. They also explain how long certain symptoms should last for before a diagnosis should be made. 

  To get a diagnosis of psychotic depression, the psychiatrist must think that you have:

  • symptoms of moderate or severe depression, and
  • symptoms of psychosis, and
  • had these over a period of time.

  The criteria in ICD-11 and DSM-5 are slightly different. 

  DSM-5 is not online. But you can read the ICD-11 criteria here

• How is psychotic depression treated?

  If you are diagnosed with psychotic depression you will normally be offered: 

  • medication - usually antidepressants and antipsychotics
  • talking therapy – you might be offered cognitive behavioural therapy (CBT) or other forms of talking therapy
  • social support – support with things like work, housing, or education

  If your symptoms are really severe, treatment in hospital can help, before being discharged into the community.

  You can find out more about treatments for psychosis and depression in our information on: 

  • Depression
  • Psychosis

  You can find out more in our information on our webpage on Going into hospital for mental health treatment 

  What is electroconvulsive therapy (ECT)?

  Electroconvulsive therapy (ECT) is a treatment for some mental illnesses.  You might be offered ECT if you are experiencing psychotic depression and other treatments have not worked. 

  ECT uses an electrical current which passes through your brain. The current causes a fit or seizure. 

  The NHS say that ECT is generally safe. It can cause some side-effects.

  You can find out more in our information in our webpage on Electroconvulsive therapy (ECT)

• What can I do if I think I have psychotic depression?

  If you think you have psychotic depression you can:

  • Contact your local NHS early intervention in psychosis team (EIT),
  • See you GP,
  • Contact the NHS on 111 or go to their website 

  If you need urgent help, see What if I need urgent help? below.

  You can find out more in our information in our webpage on GPs and your mental health 

  What are NHS early intervention in psychosis teams (EIT)?

  NHS early intervention in psychosis teams (EIT) should support you if you experience psychosis for the first time.  

  The National Institute for Health and Care Excellence (NICE) say that EIT services should be open to people of all ages.    And you should start your treatment within 2 weeks of being referred. 

  You can usually self-refer to your local EIT. This means that you can contact them and ask for help, without first seeing your GP or another medical professional.  Usually your family or friends can refer you too.  

  You should be able to find your local EIT on the internet. You can use a use a search term like ‘NHS early intervention psychosis team Leicestershire’.  Or you can call NHS 111 and ask for contact details for your local team.  Or you can ask your GP to refer you.

  What if I need urgent help? 

  If you need urgent help Contact NHS 111 for urgent mental health support. Or visit their website.

  You will need to answer some questions. They will refer you to an appropriate service or tell you what to do next.

  For other urgent mental health support options, see our Get help now link

  You can find out more in our information on:

  • Self-harm
  • Suicidal thoughts - How to cope

   

• What can I do to help myself?

  Below are some ideas for self-care and management.

  What are peer support and self-management programmes?

  Peer support means that you get support from people who live with mental illness too. 

  You can get peer support by joining a support group, or
  You may be able to get peer support and self-management programmes through your mental health team.

  You can search for local support groups below:

  You can search for local mental health support groups below:

  • Rethink Mental Illness
  • Local Minds

  Peer support and self-management programmes might be able to give you information and advice about:

  • how medication can be helpful,
  • help you to notice and manage your symptoms,
  • how to access mental health support,
  • how to access other support services,
  • how to cope with stress and other problems,
  • what to do in a crisis,
  • help you to build a social support network,
  • help you to notice when you are becoming unwell, and
  • help you to set personal recovery goals. 

  What are recovery colleges? 

  Recovery colleges are part of the NHS. They offer free mental health courses to help you manage your symptoms. They can help you to take control of your life and become an expert in your own wellbeing and recovery.  

  You can usually self-refer to a recovery college.

  Unfortunately, recovery colleges are not available in all areas. Search online to see if there is a recovery college in your area.

  What is a wellness action plan (WAP)?

  A WAP looks at things like how you are affected by your illness. And what you could do to manage your symptoms.

  There are guides that can help with this. You can ask your healthcare professional to make one with you. Or ask them for a template.  

  You can read more about wellness action plans here 

  You can see an example of a wellness action plan here 

  How can I manage voices I hear?

  Is it important to some people who live with psychosis to manage the voices they hear with alternative methods to medication.

  These resources might help, including one for carers:

  Eleanor Longden – The voices in my head
  This video tells Eleanor’s story about the voices she hears. She talks about her journey back to better mental health. She makes the case that by learning to listen to her voices she was able to survive. Website

  
  The BBC – Why do people hear voices in their heads?
  This BBC radio programme looks at what causes people to hear voices. You can listen to it online or download it. Website

  
  Understanding Voices
  A website produced by Durham University together with mental health professionals, voice-hearers and their families. The website aims to make it easier for people to find information about different approaches to voice-hearing. It includes ways of supporting those who have challenges with the voices they hear. Website

  
  Me and My Mind
  A website produced by the South London and Maudsley (SLaM) NHS Foundation Trust. The service is for young people in the SLaM area. But there is lots of useful information on the website and resources you can download. Website

  
  Avatar Therapy
  Researchers have been looking into how computer-based treatment may help with hearing voices.   This treatment is known as avatar therapy. Avatar therapy is not available on the NHS currently. 

  In this therapy you create a computer-generated face with a voice which is like a voice you hear. This is called an ‘avatar’.  You work with a therapist to talk to the avatar and gain more control over the voice you hear.

  Results show that this therapy is helpful for some people. But there is more research taking place.  Avatar Therapy UCL webpage 

  
  Caring for someone with psychosis or schizophrenia
  This is a free, online course provided by Kings College in London. It is aimed at people who care for people who live with psychosis or schizophrenia.  Website

  
  NHS self-help guide - Hearing voices and disturbing beliefs
  This booklet is for people who experience voices or disturbing beliefs. It has been produced by a group who have personal experience of hearing voices and disturbing beliefs.  It incudes information as well as space to write in your own experiences. Website

  Are there any self-help guides for depression and low mood?

  Northumberland, Tyne and Wear NHS Foundation Trust
  This NHS trust has produced a self-help guide for Depression and low mood. Website

  What about other self-help?

  There are things that you can do to help yourself to try to reduce the effect of the symptoms of psychotic depression.

  Everyone is different, so you can find out what works for you.

  You can:

  • Eat healthy foods and have a balanced diet
  • Keeping physically active
  • Have enough sleep
  • Avoiding alcohol, drinking only moderately or cutting down
  • Avoiding smoking or cutting down
• What if I am worried that a loved one has psychotic depression?

  You can encourage your loved one to contact their local NHS early intervention in psychosis team (EIT) or GP.  Or you can contact them yourself.

  For more information on EITs see ‘What can I do if I think I have psychotic depression?’ then ‘What are NHS early intervention in psychosis teams (EIT)?’ above.

  If your love one is experiencing psychosis they might not be aware that they are behaving in a way others might think is unusual. This is often called ‘lacking insight.’ So, sometimes they might not want to reach out for help.

  If you think your loved one needs urgent health their mental health, you can get more advice in our information on Getting help for someone in a mental health crisis. 

  You can get more information in our webpages on:

  • Suicidal thoughts - How to support someone
  • Supporting someone with a mental illness
  • Worried about someone's mental health?
• Katie's story

  'Psychosis from a different angle' - Katie's story

  Katie, who works as a therapist in the NHS, reflects on her personal experience with psychotic depression, as well as her father’s.

  After witnessing her father’s psychotic episode last year, Katie saw the condition from a new perspective and gained greater insight into her own recovery journey.

  Below you can read Katie's story:

  • Psychosis from a different angle
• Useful contacts

   

  The Hearing Voices Network (HVN)
  They give information, support and understanding to people who hear voices and those who support them. They also support people who have visual hallucinations and people who have tactile sensations. They have a list of self-help groups across the country.

  Email: info@hearing-voices.org
  Website: www.hearing-voices.org

   

  Intervoice
  Intervoice are a charity that encourage people all over the world to share ideas through their online community. You can also find information about hearing voices through their articles and resources.

  Email: info@intervoiceonline.org
  Website: www.intervoiceonline.org

   

  Mood Swings Network
  This service provides a range of services for people affected by a mood disorder such as depression, including their family and friends.

  Telephone: 0161 832 3736
  Address: 36 New Mount Street, Manchester, M4 4DE.
  Email: info@moodswings.org.uk
  Website: www.moodswings.org.uk

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