The depression-only group never had the mild highs or hypomanias characteristic of bipolar disorder, type 2, or the severe highs characteristic of bipolar disorder, type 1.
We observed that people with bipolar disorder, type 1 had about a five times higher rate of psychotic symptoms in their depressions than did the other two groups; more than 25 percent of their depressions were psychotic compared with 6 percent for bipolar disorder type 2 and for depression only.
What this means is that the more severe form of depression is strongly associated with the most severe type of mood disorder.
What about the implications for treatment?
Psychotic depression is often treated with both an antidepressant medication and also an antipsychotic medication. The research to date shows that this combination is more effective than using an antipsychotic medication alone -- and although it is probably more effective than an antidepressant alone, this has not been conclusively proved.
Electroconvulsive treatment, sometimes called "shock therapy," is often an effective alternative to medication for these very ill patients. Consideration should also be given to whether the patient has bipolar disorder and might need mood stabilizer medication.
Psychotherapy, or talk therapy, tends to have little impact in helping to treat madness, or psychosis, as these patients typically do not have the reasoning power with which to unlock the doors to the prison of false belief in which they are locked up. Directly altering the chemistry of the brain provides the key to releasing them from the throes of illness.
When treatment takes hold, patients' moods improve; the depression lifts. And the delusional beliefs disappear.
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