What should you know about psychotic depression symptoms?

A person may feel persistently hopeless, lose interest in normal activities, move or speak more slowly, sleep poorly or sleep excessively, and struggle with energy or concentration. Psychotic features can include hearing a voice when no one is speaking, seeing something others cannot see, or developing an unshakeable belief of being blamed, watched, ruined or seriously ill. The emotional tone can be very low, fearful or agitated. People may hide symptoms because the experiences feel private or frightening.

Depression may also present with fatigue, irritability, feeling anxious, difficulty sleeping, daytime sleepiness or difficulty concentrating. These symptoms can have many causes, so their presence does not identify psychotic depression. The direction matters: psychotic depression presents with these possible changes; an isolated symptom does not prove the condition.

Arrange prompt assessment with a doctor or mental-health professional, and describe the exact words, experiences and behaviour you have observed. Mention new medicines, missed doses, alcohol or drug use, major sleep loss and physical symptoms. Support regular food, fluids and a calm routine if this is safe. Do not stop prescribed medicine suddenly or promise that a frightening experience is imaginary; listen without endorsing the belief and help the person access care.

Seek emergency help for suicidal thoughts, threats, command hallucinations, severe agitation, confusion, inability to care for basic needs, or behaviour that places anyone in immediate danger. Stay with the person if you can do so safely, keep the surroundings quiet and remove obvious hazards. Contact local emergency services when rapid help is needed.

Ask which symptoms need same-day review, whether another health problem or substance could be contributing, how to record changes, what support is available at home, and what to do if the person refuses care.