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Major Depression Without Psychotic Features

Major Depressive Disorder Causes

Major Depressive Disorder (MDD) With Psychotic Features

If there is a history of Major Depressive Disorder in close family members, and especially in immediate family members , then the risk for a major depressive episode will be three times more likely.


Biological causes such as levels of serotonin, norepinephrine, and dopamine, can cause depression or other symptoms if levels are low.

Obsession and compulsion due to serotonin deficiency Attention and anxiety with low levels of nor-epinephrine Attention, motivation, and pleasure with low levels of dopamine Other biological factors may include tryptophan deficiency, which the body uses to make serotonin


Loss of someone due to death or divorce Sexual or emotional abuse

Risk factors of Major Depressive Disorder

Major Depressive Disorder is not limited to adults and elderly populations. A substantial proportion of patients experience their first episode of major depression during their developmental years.

There are four major risk factors associated with major depression: Gender: major depression is higher in females than males Poor lifestyle Traumatic childhood experience Specific personality traits

Studies in the United States showed an estimation of 17% of the population has experienced or is experiencing major depression. Another study found that nearly 5% of the population reported meeting criteria for major depressive disorder in the last 30 days.

Major Depression A Chronic Illness

Major depression is a serious mental illness. It is classified as a mood disorder, which means that it is characterized by negative patterns in thoughts and emotions that dont line up with a persons actual circumstances. It is also a chronic mental illness. This means it is not curable and that it can come and go, sometimes for a persons entire life. Someone diagnosed with depression may feel fine for a long period of time and then have symptoms. The period during which someone experiences the symptoms is called a depressive episode.

Most people with major depression live with it as a chronic illness. Episodes come and go, although they may be made less severe and less frequent with good treatment. In some cases, though, a person may experience a singular episode of depression, just once in a lifetime. Often these episodes of depression are triggered by a situational event: a death in the family, the loss of a job or relationship, or some kind of trauma, like a physical assault. This single depressive episode may be just as serious as those experienced by someone with recurrent major depression, with all the same symptoms and persistence.

Mood Congruent And Mood Incongruent Psychotic Symptoms

The diagnostic and prognostic importance of mood congruent and mood incongruent psychotic symptoms in mood disorders is the subject of ongoing discussion. Some investigators propose that mood incongruent psychotic features indicate a distinct subtype of psychotic depression with a worse prognosis regardless of the severity of depression . This point of view appeared to be supported by a finding that mood incongruent psychotic features aggregated in families and predicted a more severe course . In the Research Diagnostic Criteria, mood disorders with mood incongruent psychotic symptoms are grouped under schizoaffective disorder, based on the concept that mood incongruence conveys a worse course of mood disorders . On the other hand, there is considerable heterogeneity of outcome in these patients .

Regardless of how psychosis is categorized, the bulk of evidence suggests that there is no difference in outcome between psychotic depression with mood congruent versus mood incongruent symptoms . One point about which there is growing consensus is that mood incongruent psychotic symptoms convey greater likelihood of bipolar than unipolar depression .

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Getting Help For Others

People with psychosis are often unaware that they’re thinking and acting strangely.

As a result of this lack of insight, it’s often down to the person’s friends, relatives or carers to seek help for them.

If you’re concerned about someone and think they may have psychosis, you could contact their social worker or community mental health nurse if they’ve previously been diagnosed with a mental health condition.

Contact the person’s GP if this is the first time they’ve shown symptoms of psychosis.

If you think the person’s symptoms are placing them or others at possible risk of harm you can:

Who Is At Risk For Depression


Depression can affect anyone, no matter their age, gender or circumstances. About 16 million Americans experience depression each year.

Women may experience depression more often than men. And your genetics or other health conditions can increase the likelihood that youll have at least one depressive episode in your lifetime.

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Treatment For Psychotic Depression

If you experience both depression and psychosis, youll want to get support from a mental health professional right away. This condition typically doesnt improve without professional treatment.

Your care team may recommend a short stay in a psychiatric hospital to treat severe psychosis and persistent thoughts of self-harm or suicide.

Treatment for psychotic depression generally involves psychotropic medications, though you have other options, too.

Treating Major Depressive Disorder

While depression is a serious condition, it can be treated. In fact, between 80% to 90% of people with depression respond well to treatment, and almost all patients get some relief from their symptoms.

Its important to seek treatment for depression as soon as possible, because the earlier it is treated, the more effective the treatment can be. Ignoring the symptoms of depression and leaving it untreated can lead to self-harm or death.

Treatment for depression may involve medication, therapy, or brain stimulation. The treatment modalities chosen can depend on the severity of the depression and your individual needs.

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Psychotic Depression Vs Major Depression

MDD, or clinical depression, can affect your mood, behavior, everyday life, and physical health.

An episode of major depression typically involves:

  • a persistent low mood or a loss of interest in everyday life for at least 2 weeks
  • four or more other symptoms of depression

Psychosis isnt included in the nine main symptoms of depression, and many people living with MDD never experience psychosis.

The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition classifies the two separately, listing depression with features of psychosis as Other Specified Depressive Disorder.

Depression is always serious. Still, experts tend to consider MDD with psychosis more serious than depression without psychosis because its more likely to involve:

Psychosis involves a break or disconnect from reality, so people experiencing it arent necessarily aware of their symptoms, which can include:

  • hallucinations, or seeing, hearing, and feeling things that arent real
  • delusions, or believing things that arent true
  • psychomotor impairment, or slowed thoughts, movements, and feelings
  • a state of stupor, where youre unable to move, speak, or respond to your environment

Psychotic hallucinations and delusions might involve:

Experts separate MDD with features of psychosis into two categories:

Psychotic Depression And Trauma

What are Depression and Bipolar with Psychotic Features?

Since depression is a common feature of PTSD, psychotic depression in a patient with a history of trauma can be very difficult to differentiate from PTSD with psychotic features . Whether or not symptoms of comorbid PTSD are present, it is not known whether psychotic symptoms that directly reflect traumatic experiences in a depressed patient have different therapeutic or prognostic implications than mood congruent psychotic symptoms. The speculation that some of the relative treatment resistance reported with psychotic depression may be due to unrecognized PTSD has not been studied. It is not yet clear whether treatment of the combination of posttraumatic symptoms, depression, and psychosis should be similar to the treatment of psychotic depression in the absence of a significant trauma history.

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How Is Depression Syndrome Diagnosed

Everyone may feel sad or down from time to time. However, clinical depression has more intense symptoms that last two weeks or longer.

To determine whether you have clinical depression, your healthcare provider will ask questions. You may complete a questionnaire and provide a family history. Your healthcare provider may also perform an exam or order lab tests to see if you have another medical condition.

What Can I Do If I Have Depression

If you have symptoms of depression, see your healthcare provider. They can give you an accurate diagnosis, refer you to a specialist or suggest treatment options.

If you or someone you know is thinking of hurting themselves or taking their own life:

  • Go to the emergency department of your hospital.
  • Contact a healthcare provider.
  • Speak to a trusted friend, family member or spiritual leader.

A note from Cleveland Clinic

Depression is a common condition that affects millions of Americans every year. Anyone can experience depression even if there doesnt seem to be a reason for it. Causes of depression include difficulties in life, brain chemistry abnormalities, some medications and physical conditions. The good news is that depression is treatable. If you have symptoms of depression, talk to your healthcare provider. The sooner you get help, the sooner you can feel better

Last reviewed by a Cleveland Clinic medical professional on 12/31/2020.


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Major Depressive Disorder Without Psychotic Features

Faculty of Medicine, Universitas Udayana, Denpasar, Bali, Indonesia

Correspondence to: Sri Dashinie Sri Renganathan, Faculty of Medicine, Universitas Udayana, Denpasar, Bali, Indonesia.



Major depression is one of the four basic forms of mood disorder. It is considered as a serious medical illness that affects a persons behavior, feeling, mood, thoughts and also health. A patient is associated with major depression when he or she possesses at least five of these clinical symptoms sadness , lack of concentration, sleeping disorder such as insomnia and hypersomnia, fatigue, loss of interest, lack of appetite, excessive guilt, unworthy feeling and suicidal thoughts. The mentioned symptoms should be present for a minimum period of two weeks for the diagnosis of major depression to be established. Left untreated, major depressive disorder may interfere with daily life activities and eventually leads to suicide, which is one of the leading cause of death in the United States. In this report, the referred case study for major depressive disorder will be the scenario of a 30 year old woman who attempted suicide by consuming 8 bodrex pills. She was given psychotherapy and treated with antidepressant of selective serotonin reuptake inhibitor group which indeed showed a good improvement on her health.

Keywords: Major depressive disorder, Psychotic features, Suicidal ideation

Symptoms Of Major Depressive Disorder


These are some of the symptoms of major depressive disorder you may experience:

  • Feeling sad or low
  • Having difficulty paying attention, remembering, or making decisions
  • Having difficulty sleeping, waking up too early, or oversleeping
  • Experiencing unplanned changes in eating habits and weight
  • Experiencing headaches, cramps, digestive issues, or other aches and pains that dont have a clear cause and dont get better with treatment
  • Talking about death, having thoughts of suicide, or attempting self-harm

Everyone experiences depression differently. While some people may have a few symptoms, others may have many. The frequency, severity, and duration of the symptoms can also vary from person to person.

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Can Depression Be Prevented

You can help prevent depression by getting enough sleep, eating a healthy diet and practicing regular self-care activities such as exercise, meditation and yoga.

If youve had depression before, you may be more likely to experience it again. If you have depression symptoms, get help. Care can help you feel better sooner.

What Is Samhsa’s National Helpline

SAMHSAs National Helpline, , or TTY: is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 to find help near you. Read more about the HELP4U text messaging service.

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Major Depressive Disorder Recurrent Severe Without Psychotic Features

    2016201720182019202020212022Billable/Specific Code
  • F33.2 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
  • Short description: Major depressv disorder, recurrent severe w/o psych features
  • The 2022 edition of ICD-10-CM F33.2 became effective on October 1, 2021.
  • This is the American ICD-10-CM version of F33.2 – other international versions of ICD-10 F33.2 may differ.
  • Applicable To annotations, or

Missed Diagnosis Of Psychotic Depression

Major Depressive Disorder

Data from the National Institute of Mental Health Study of the Pharmacotherapy of Psychotic Depression indicates that clinicians frequently miss the diagnosis of psychotic depression, in large part, due to a lack of recognition of the psychotic features. In the STOP-PD Study, 27% of 130 diagnoses among a well-characterized sample of patients with a research diagnosis of psychotic depression were initially incorrectly diagnosed. It is likely that the missed diagnosis rate observed in this study was a conservative estimate of the rate in the general clinical population because patients with comorbid conditions such as a history of substance abuse in the past 3 months or unstable medical conditions were excluded. Psychotic depression was most commonly misdiagnosed as major depressive disorder without psychotic features, depression not otherwise specified , or mood disorder NOS. It was quite striking that none of the patients with missed diagnoses were considered to have a psychotic disorder. This finding suggests that the clinicians were missing the psychosis rather than the mood disorder.

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Distribution Of Sociodemographic Factors And Clinical Characteristics

The distribution of sociodemographic factors and clinical characteristics is presented in Table . Patients with PMD were significantly more educated than patients with NMD and SZ . Patients with SZ were significantly younger at the first psychotic episode than those with PMD. No statistically significant differences were observed between the PMD and NMD groups age of onset . The percentage of unmarried patients in the PMD group was significantly lower than that in the SZ group , but was not significantly different to the NMD group . Patients with SZ were significantly less likely to have a history of allergy compared with patients with PMD . There was no significant difference in allergy history between the PMD and NMD groups .

Table 1 Distribution of socialdemographic factors and clinical characteristics

How Do You Know If Youre Having A Nervous Breakdown

“Nervous breakdown” is not a medical term, but it is often used colloquially to mean intense mental and emotional distress.

In terms of major depressive disorder, symptoms of psychosis, including hallucinations and delusions, can occur. When this happens, it is called MDD with psychotic features, or psychotic depression.

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What Is Major Depressive Disorder

Major depressive disorder is a serious mental illness that affects how people feel, think, and go about their everyday tasks. The condition can also impact a persons sleep habits, appetite, and ability to enjoy life.

Major depressive disorder isnt something that eventually passes.

  • While most people feel sad at times in their lives, major depression is when a person is in a depressed mood most of the day, nearly every day, for at least two weeks. Some people feel depressed without knowing why. The onset can happen at any age, but usually begins in adulthood. People may only have one depressive episode, but most have multiple episodes over time.

    While the exact causes of major depression are unknown, some risk factors include a family history of depression and significant life events such as trauma, times of high stress, loss of a job or relationship, or the death of a loved one. People with a serious medical illness such as heart disease, cancer, diabetes, or Parkinsons disease, may be at an increased risk of developing major depression.

  • Epidemiology And Risk Factors

    Depression: Depression With Psychotic Features

    Major depression is a common disorder and is reported to have a lifetime prevalence of 16.2% and a prevalence of 6.6% for the past 12 months in U.S. adults, with an increased risk in women.4 The reason for increased rates of major depressive episodes in women is unclear, but it might include hormonal factors as well as differences in psychosocial stressors, and it is likely that the increased rates of both insomnia and depression in women are related. In contrast to major depression, bipolar I and II disorders each affect about 1% of the population and show no sexual predilection.5 Most bipolar disorder patients have at least one other DSM-IV comorbidity and are more likely to have a persistent course and severe impairment.5 Major depression and bipolar disorders have an onset in early adulthood the median age for major depression is 32 years and for bipolar disorders 18 to 20 years.5 Major depression and bipolar disorder both usually have recurrent episodes with recovery between episodes. However, increased number and severity of episodes and poorer interepisode recovery can lead to an overall worse prognosis, suggesting that chronic treatment may be beneficial for patients with recurrent illness.

    Farideh Eskandari, ⦠Giovanni Cizza, in, 2004

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    What Causes Psychotic Depression

    The cause of psychotic depression is not fully understood. It’s known that there’s no single cause of depression and it has many different triggers.

    For some, stressful life events such as bereavement, divorce, serious illness or financial worries can be the cause.

    Genes probably play a part, as severe depression can run in families, although it’s not known why some people also develop psychosis.

    Many people with psychotic depression will have experienced adversity in childhood, such as a traumatic event.

    Treatment for psychotic depression involves:

    • medicine a combination of antipsychotics and antidepressants can help relieve the symptoms of psychosis
    • psychological therapies the 1-to-1 talking therapy cognitive behavioural therapy has proved effective in helping some people with psychosis
    • social support support with social needs, such as education, employment or accommodation

    The person may need to stay in hospital for a short period of time while they’re receiving treatment.

    Electroconvulsive therapy may sometimes be recommended if the person has severe depression and other treatments, including antidepressants, have not worked.

    Treatment is usually effective, but follow-up appointments so that the person can be closely monitored are usually required.

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