Psychotic depression is a term used to describe a depressive illness that is characterised by depression associated with psychotic symptoms. It can occur in the context of bipolar disorder or so called unipolar depression. Either way, the treatment is similar.


The depressive symptoms are the same as those seen in any other depression. Psychosis generally refers to experiences similar to the ‘positive’ symptoms seen in schizophrenia: delusions, hallucinations and thought disorder. Those in psychotic depression have particular characteristics:

  • The delusions tend to be of a very negative kind, so called 'nihilistic' delusions. For instance believing ones’ body is rotting away or that one is in a state of extreme poverty.
  • The hallucinations, usually voices, tend to back up the delusions and may be telling the person to kill him or herself.
  • Thought disorder is less characteristic of psychotic depression.
  • These symptoms are mood congruent, in that they are consistent with feeling very depressed.
  • Generally speaking, psychotic symptoms only tend to occur in severe depression.

Best Evidence-Based Treatments

Medication is generally considered key to the treatment of psychotic depression and both anti-depressant and anti-psychotic medication is required. The evidence-base is less extensive than for unipolar and bipolar depression but psychological approaches are important, although may not be possible until medication has started to work.

In the most severe forms of depression, electroconvulsive therapy (ECT) may be the most effective treatment.

The psychological therapies are the same as for depression.

Elite Psychology comprises of an expert team, specialising in the range of best private evidence-based treatments for psychotic depression. Our highly qualified associates are accredited in all of the most successful therapies, complemented by psychiatrists who can prescribe anti-depressants on private prescriptions. We can assess you and provide the most efficacious therapy tailored to your difficulties. We know the importance of being understood, and endeavour to deliver the highest standard of psychological interventions to meet your needs.

Call us on 020 3815 7935 for further information or to book an assessment. Alternatively you can complete the online contact form.