Clinical Symptoms and Treatment of Severe Depression - Melancholic and Psychotic Depression

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 (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
👉Show 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

⛑ Patients with psychotic depression have double the risk of dying than non-psychotic depression and higher odds of completed suicide. [Vythilingam M et al., 2003]., [Gournellis R et al., 2018]
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
Read more on melancholic and psychotic depression:

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