Insights into Effective Treatments for Psychotic Depression

Insights into Effective Treatments for Psychotic Depression
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The most effective treatments for psychotic depression are administered in two phases – short term and long term. Short term treatment focuses on stopping a dangerous psychotic episode while long term treatment focuses on the patient controlling depression symptoms and recognizing when a psychotic episode is about to begin.

Problems with Diagnosis

The hardest part of treating psychotic depression is getting it diagnosed. Unfortunately, a patient must first experience a psychotic episode and then have that and any other symptom compared to other mental illnesses like dementia, bipolar disorder, schizophrenia or antidepressant induced psychosis.

According to the University of Massachusetts Memorial Medical Center, 16 to 54% of all depressives suffer from psychotic depression. People especially at risk at being misdiagnosed are children who suffered sexual abuse and the elderly. Having delusions or hearing voices is not a normal part of aging.

Short Term Treatment

Watching someone go through a psychotic episode is a frightening experience. But even more frightening is to undergo the episode. The patient may feel attacked from all sides, cannot trust anyone and may not realize that they are hallucinating. People in this state are dangers to themselves and the general public. They have lost all rationality. This is why people need to be hospitalized immediately during an episode.

The goal of short term treatments for psychotic depression is to stop the psychotic episode and pull the patient back to rationality. A diagnosis is not usually given at this time. Depending on the available facilities and the patient’s personal health history, short-term treatment can be heavy sedation with antipsychotic drugs or electro-convulsive shock therapy (ECT).

Long Term Treatment

Psychotic depressives only experience periods of psychotic episodes and do not suffer from psychosis all of the time. Once they regain lucidity, they can begin tests to determine a diagnosis and to begin long term treatment.

The National Institute of Mental Health (NIMH) currently supports two types of treatments for psychotic depression – ECT or a combination of atypical antipsychotic drugs and antidepressants for at least 12 weeks. A side effect of these drugs is sudden weight gain, so the patient needs to go on a diet and exercise program while taking the medications.

NIMH states that the best treatment is ECT, although its effects are short term. In any case healthcare professionals have found that some people are too scared to try it, having been influenced by movies like “One Flew Over the Cuckoo’s Nest” (1975.) Another problem is that many hospitals do not possess the necessary equipment and/or trained personnel to administer ECT.

Another long term treatment is cognitive behavior therapy (CBT) during periods when the patient is rational. This can also be used in combination with ECT or medications. CBT helps a patient recognize delusional symptoms from reality. A patient is better able to do this with medication than without. The patient also needs support from friends and family to help him or her recognize delusions from reality. CBT has been used successfully in other mental illnesses with psychotic episodes such as schizophrenia. However, one disadvantage is that it can take weeks or months before its beneficial effects are felt by a patient.

Setbacks are inevitable for anyone suffering from psychotic depression, but symptoms can be managed through medications and therapy for the rest of the person’s life.

Sources

Psychiatrist.com. “New Approaches to Managing Psychotic Depression.” Alan M. Shatzberg, MD. https://www.psychiatrist.com/pcc/pccpdf/v05s01/v64s0104.pdf

University of Massachusetts Memorial Medical Center. “Psychotic Depression: New Treatment Means New Hope.” https://www.umassmemorial.org/MedicalCenterIP.cfm?id=3822

Monash University. “Child Abuse Link to Psychotic Illness.” Nov. 4, 2010. https://www.monash.edu.au/news/newsline/story/1693

National Institute of Mental Health. “Combination Treatment for Psychotic Depression Holds Promise.” Aug. 7, 2009. https://www.nimh.nih.gov/science-news/2009/combination-treatment-for-psychotic-depression-holds-promise.shtml