A symptomatic complex in-which psychotic features, as they are defined today (i.e., delusions and hallucinations), emerge within an episode of depression. When psychotic features occur in a depressive episode of unipolar clinical (major) depression or bipolar disorder, the depression is typically severe and the psychotic features mood-congruent (i.e., depressive-themed), e.g., voices from the bottomless chasm of hell condemning the patient or urging them on to suicide, depressive delusions (e.g., of nihilism, poverty and/or well-deserved persecution, which, unlike the persecutory ideation of the paranoid schizophrene, is felt as deserved and a suitable punishment for their sins, rather than an unfair targeting by the CIA). In the context of schizoaffective disorder wherein depressive episodes occur, the psychosis is less inherently mood-congruent.
(Psychotic depression.) The fact that depression, when severe, can be psychotic and even (more-so than in schizophrenia these days) catatonic is a fact that’s well-known to people who truly know what severe depression is but often unknown or brushed down in casual discourse about depression, among GPs, pharmacists (who tend to deal with what can be standardised on a more generic primary-care level, so typically mild) and even psychology-teachers. By the time we’re talking irreversible MAOIs, electroconvulsive therapy (unfairly stigmatised), Cotard’s syndrome and catatonic stupor, this is no-longer ‘the common cold (not even ’flu., still) of psychological problems’ that people who don’t know any better attribute depression to, out of ignorance, while simultaneously highlighting that schizophrenia is the psychological equivalent of cancer. Severe depression, psychotic or not, is often described as a kind of suffering worse than cancer in people who have suffered from both illnesses.
by Doc_B February 5, 2026
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