Depression with delusions or voices requires rapid specialist help. Read what this means, what treatment is possible and what loved ones can do.
Psychotic experiences can feel very convincing and affect safety or self-care. This page provides explanations for patients and relatives; do not wait for self-help in case of new or increasing symptoms.
Zorgfuik provides general information and does not make a diagnosis. Discuss personal symptoms, treatment and medication with a qualified healthcare provider.
Sources checked for . Information for adults and relatives; new psychotic symptoms require professional assessment.
In severe depression, contact with reality can be disrupted. For example, someone may have delusions or hallucinations. The belief that something terrible is happening can feel completely real to that person, even if others don't recognise it.
A strong belief that does not match reality and is difficult to correct. For example, that you have caused a disaster, that your family has been ruined through your fault or that a body part no longer exists. The content alone does not provide a diagnosis.
Perceptions that others do not share, such as hearing voices without anyone speaking. Voices can be accusatory or threatening. Also tell a care provider if voices give orders.
Psychotic experiences do not automatically mean schizophrenia. They can occur with various conditions and conditions. In psychotic depression, the psychiatrist assesses how the experiences are related to the depressive episode.
NHS: psychotic depression and NIMH: Understanding psychosis.
Severe guilt or worry is not automatically a delusion. The healthcare professional examines, among other things, persuasion, sense of reality, mood, behaviour and progress. An online test or discussion with a loved one cannot replace that research.
The assessment also covers food, drink, sleep, medication, alcohol or other drugs, and physical health. For example, sudden confusion may have a physical cause. Previous manic episodes or a recent birth also change the decision.
Report immediately if someone no longer moves or speaks, no longer drinks, seriously neglects themselves or wants to harm themselves. Such signals may require intensive medical and psychiatric care.
Thuisarts: psychosis and help and Dutch diagnostics guideline.
Treatment takes place in specialist mental health care. The team assesses whether intensive care at home can be done safely or whether admission is necessary. The choice depends on physical condition, risks, support and preferences. Not everyone with psychotic symptoms is automatically admitted.
The Dutch guideline usually recommends a combination. The antidepressant targets the depression; the antipsychotic targets psychotic symptoms. Using only one of these is not the recommended standard treatment for psychotic depression.
Ask what effect is expected and what monitoring is needed. The medicines and dosages are chosen for the individual; do not combine or stop yourself.
ECT can be used early if a quick effect is needed, for example in the event of life-threatening food or fluid refusal or serious suicide risk. So it is not just a final step after years of trying.
An epileptic seizure is induced in a controlled manner under short anesthesia and with a muscle relaxant. This is done in a medical treatment environment, with monitoring and repeated evaluation.
With ECT you discuss, among other things, anesthesia, headache, temporary confusion and memory problems. Memory symptoms can sometimes last longer. Ask how the team follows this and what alternatives are available. Discussions, practical support and recovery care remain important in addition to biological treatment.
Guideline: treatment of psychotic depression and UMCG: ECT. See also specialist treatment options.
You do not have to make a diagnosis at home or decide on compulsory care. This is a professional assessment with its own conditions. You can provide important information and indicate that you cannot handle the situation safely.
Practical elaboration of NIMH: help for psychosis and Thuisarts.
If delusions or voices diminish, the depression may still be present. Restoring concentration, confidence, daily tasks and relationships can take time. Also discuss shame or sadness about what happened during the crisis.
The treatment is not automatically stopped as soon as someone seems calmer. Ask about continuation of medication, side effects, follow-up contacts and the plan for possible reduction. After ECT, follow-up treatment is also necessary to help prevent relapse.
Create an alert plan with your own early signs, contact persons and crisis appointments. Determine who supervises physical recovery and who maintains an overview when multiple professionals are involved.
Guideline: continued treatment and UMCG: follow-up after ECT.
Self-help is not a substitute for treatment in acute psychosis. If you have thoughts of suicide you can also call day and night 0800-0113 or chat via 113 Suicide Prevention; call if there is immediate danger to life 112.
Further reading: psychosis after childbirth, bipolar depression and the care process.
That during a depressive episode delusions or hallucinations also occur, such as voices or beliefs that do not match reality. This requires specialist assessment.
No. Psychosis can occur with various conditions. The course, the relationship with mood and possible other causes are being investigated.
For psychotic depression, a combination of an antidepressant and an antipsychotic is often recommended. ECT may also be considered and sometimes required early for life-threatening severity.
For example, in the case of severe or life-threatening symptoms, insufficient food or drink, high suicide risk or insufficient effect of other treatment. The team discusses benefits, risks and alternatives.
Yes. Temporary confusion and memory symptoms may occur; some memories may remain disturbed for longer. Discuss before and during the treatment how this will be monitored.
Acknowledge the fear or tension without confirming the belief as fact. Don't argue fiercely. Seek professional help and ensure your own safety.
In case of immediate danger to life. In the event of new psychotic symptoms or a mental health crisis, immediately call your GP, out-of-hours GP service or your own crisis team for assessment.
