Those of us who experienced severe childhood trauma are at a substantially higher risk of developing depression as adults than those lucky enough to have had a relatively stable upbringing. However, it is not well known amongst the general public that, in a minority of cases, depression can be so severe that it involves disturbing psychotic symptoms (estimates suggest that about 13% of those who suffer from serious depression will experience psychotic features, and this percentage can rise steeply amongst geriatric populations – perhaps as high as 50%). It is these symptoms that I will describe in this article.
Symptoms of Psychotic Depression :
Symptoms of psychotic depression may include the following:
1) DISJOINTED THINKING – The ability to think can become severely impaired and the thoughts a person has may become very muddled and confused, rapidly flitting from one subject to another. This can make concentration impossible and lead to speech patterns which are difficult for others to follow and understand.
2) AGITATION/PACING – During my own illness I suffered very badly from this. For years I was so agitated I could not often sit down for long, and, even if I was sitting, certainly found it impossible to physically relax in a chair; I was, almost literally, constantly on the ‘edge of my seat.’ Such serious agitation is sometimes treated with major tranquillizers (these are anti-psychotic drugs) and, indeed, it was necessary for my psychiatrist to prescribe these for me.
3) DECLINE IN SELF CARE – Again, I suffered this symptom during my own illness. I did not bath for a very long time ; instead, I would occasionally wash with a flannel. I shaved rarely, and did not use soap or shaving foam when I did (this actually makes shaving quite painful). During a particularly bad period, when I was intensely suicidal and actively planning to hang myself, I did not change my clothes for three months (click here to read about this episode of my life).
a) Of being an exceptionally bad person or ‘evil.’
These include delusions of being an exceptionally bad person, or, even, of being ‘evil’ or of being ‘the devil.’ Also, self-blame, an extremely common symptom of non-psychotic depression, may become delusional – the sufferer might, for example, start to falsely believe he has committed terrible crimes (eg mass murder or the assassination of an important figure).
Because of this, the delusional individual may believe he will soon be horribly punished for these imaginary crimes, and start to dwell obsessively upon what form the punishment might take (eg terrible eternal torture in ‘hell’ or by a malign and clandestine ‘secret police’).
b) Nihilistic delusions.
These may take the form the sufferer believing the world does not actually exist, or that eveyone in it is dead, or that he, himself, is dead.
c) Somatic delusions.
Sometimes, the psychotically depressed individual might believe part of his body is missing, such as the heart or the brain.
d) Delusions of worthlessness.
At the delusional level, ideas about being worthless become extreme. For example, a person may believe they are the most useless and worthless person in the entire world, fit only to be utterly despised, ridiculed and held in profound contempt.
The psychotically depressed may also believe that their body is wasting away, rotting and disintegrating and/or that they have some terrible, incurable disease.
e) Delusions of poverty
This involves the false belief that one has run out of money, or that one has nearly run out (even when, in fact, the individual is comfortably off), together with accompanying fears that one will starve or end up living on the streets in rags.
This involves seeing or hearing things which are not, in reality, there. The former are referred to as visual hallucinations and the latter as auditory hallucinations. For example, the individual may ‘see’ a vision of the ‘devil’ or ‘hear’ the ‘voice of god’ telling him to kill himself.
Sometimes, too, other senses may be affected. For example, food may lose all its pleasure and taste of nothing, or, even, taste unpleasant.
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David Hosier BSc Hons; MSc; PGDE(FAHE).