What should you know about psychotic depression?

Depression may bring persistent low mood, loss of interest, slowed thinking, exhaustion, changes in appetite, or disrupted sleep. In psychotic depression, a person may also hear or see things others do not, or become convinced of ideas that are not supported by evidence. The beliefs may be linked to guilt, illness, poverty or punishment. Some people recognise these experiences as unusual; others feel completely certain they are true. Family members may notice withdrawal, neglect of daily needs, or speech and behaviour that seem out of character.

Insomnia, difficulty sleeping, daytime sleepiness, fatigue, difficulty concentrating, feeling anxious and irritability can occur with depression, but they do not by themselves establish psychosis. A clinician considers the whole pattern, medicines, substance use, physical health and other mental-health conditions.

Arrange an urgent appointment with a psychiatrist, mental-health team or doctor who can assess mood, thinking, safety and physical health. Take a trusted person if the affected person agrees, especially if they are struggling to explain what is happening. Keep medicines in their original containers and mention alcohol, recreational drugs, sleep loss and any recent medication changes. Treatment may include prescribed medicine, psychological support and practical help with food, sleep and supervision; the plan is individual and needs monitoring.

Call emergency services or go to an emergency department if there are thoughts of suicide or harming someone, command voices, severe confusion, inability to eat or drink, unsafe wandering, or immediate danger. Do not argue about a fixed belief or leave someone alone when safety is uncertain. Speak calmly, reduce noise and remove accessible means of harm while arranging urgent help.

Ask what symptoms suggest psychosis, whether a physical or medication-related cause needs checking, how soon treatment should work, which warning signs require emergency help, and who should be contacted outside appointments.