Clinical Symptoms of Severe Depression – Focus on Melancholic and Psychotic Depression
Dr Sanil Rege covers the symptoms of severe depression with a focus on melancholic and psychotic features in depressive disorder.
Melancholic and psychotic depressions are both severe forms of depression associated with a high degree of morbidity and suicide risk. Features of Severe melancholic and psychotic depression:
- Psychomotor disturbance
- Impaired cognitive functioning (involvement of frontal-subcortical circuits)
- slowing of mental and motor activity
- Physical symptoms, e.g. constipation, menstrual irregularities, lowered BP
- Ruminations – themes of hopelessness, pessimism, self-accusation, self-derogation, feelings of inadequacy and of being a failure
- Periods of agitation
- More significant biological and genetic determinants than psychosocial
- Shows a minimal response to placebo
- Shows a superior response to biological treatments such as broad-spectrum antidepressant medication and electroconvulsive therapy rather than to psychotherapy.
- Psychotic depression presents with delusions: nihilistic, obsessional guilt, poverty and hypochondriacal are common themes
Psychotic depression is best conceptualised as melancholic depression with psychotic features (e.g. delusions, hallucinations, guilty ruminations).
Treatment requires broad-spectrum antidepressants in melancholic depression and augmentation strategies as second and third-line treatments.
Psychotic depression requires antidepressants and antipsychotics as initiating treatments.
More detail on melancholic and psychotic depression.