Psychosis usually strikes people suffering already with major depression. It can also strike at people who are suffering more minor forms of depressive illness. However, this is rare. Like so many mental conditions, no-one really knows the reasons, either why depression descends on someone, or psychosis decides to join in the mix.
It's unfortunate that most people don't seek direct psychiatric help, but rely on visits to their own doctors. I think there are three reasons for this and here we're discussing depressive psychosis, not merely depression. People usually know their doctor, at least know him or her better than a complete stranger, so they're going to feel more at ease talking to someone they've seen before.
Secondly, it really isn't very easy telling someone you're seeing things, or hearing strange sounds. Again, telling this to a stranger is all the more discomforting.
Thirdly, I'm afraid that this wretched stigma of mental illness is still with us even today, so going to your own doctor is a lot less suspicious than a visit to a psychiatrist.
All the following five reasons make sense to the patient, so far as seeing their own doctor is concerned. Notwithstanding, a visit either to their own doctor or a psychiatrist should trigger screening at least for depression, and more properly psychotic depression.
Firstly, people with a personal history of depression, or a history of family mental instability should certainly be screened.
Secondly, those with multiple medical problems. Bad backs, various aches and pains, headaches, etc., merit tests for depression. If patients would be totally honest with their doctors, then everyone's life would be so much easier. If the patient complained of headaches, for instance, and then was to add that life seemed so pointless, the doctor could nail the problems so much more quickly. Unfortunately, the patient herself may be unaware that anything major's wrong in the early stages. They might feel a bit low and depressed, but take no notice because they consider it natural.
The third reason is the patient with physical conditions that don't have any clear medical reasons for appearing. Headaches are the usual, of course, but back aches and general aches and pains are just as likely.
The fourth is the patient who suffers from chronic pain. Aching legs, perhaps, that give the impression that he or she may be suffering from arthritis. This is particularly difficult in older patients who could indeed be suffering the disease.
The fifth reason is the patient who visits the doctor often. The temptation here is to dismiss them as hypochondriacs, when in fact, if they're suffering from psychosis, their minds are telling them that they're suffering from a number of complaints.
Ethnic, non-Western groups, tend to suffer from headaches, constipation, and back pain. Seldom do they exhibit mood disorders.
It's always possible for severely depressed people to suffer hallucinations, but provided no psychosis is present, they know that the thoughts coursing through their minds aren't real. However, psychotic depression can bring a reality to these thoughts. They may think that the newscaster on television is trying to send them coded messages, or that the CIA are reading their minds. There have been cases where sufferers have thought that the CIA, or some other government body, is giving them secret orders to kill someone.
At this stage, the diagnosis between psychotic depression and schizophrenia becomes very difficult. Major depression must be accompanied by a very depressed state for all or most of the day, together with total loss of interest in pastimes formerly enjoyed. However, with Psychotic Major Depression, hallucinations and delusions must accompany these other symptoms. Suicidal thoughts and/or attempts are more likely as well.
PMD is unlikely to respond to placebos, nor will it do well simply on an antidepressant or antipsychotic drug. There must be a combination of the two. Electro Convulsive Therapy has been known to be successful too, but as a second line of treatment.
One interesting point. One of the side benefits of the 'abortion' pill, RU486, has been shown in limited studies to be most efficacious in the treatment of psychotic depression
Mike Bond, discussing one of the worst of the depressive diseases, psychotic major depression [http://www.panattack.com]. He's never suffered this particular affliction, but understands a form of psychosis from his days of alcoholism. This, of course, was self-inflicted. A visit to his website is well worth your while, at panattack.com [http://www.panattack.com] particularly if you suffer mental illness yourself.
He would like to thank Wikipedia for some of the information in this article
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