Why do some people with psychosis develop depression?
When we talk about psychosis, we often focus on symptoms like hallucinations or delusions, but a less visible yet equally important aspect is depressive symptoms such as sadness, lack of energy, loss of interest in daily activities, and difficulty concentrating, among others. People with psychotic disorders have a significantly higher risk of developing depression, which can appear at different times during the disorder.
The presence of psychotic symptoms has a direct impact on a person's functioning, quality of life, and environment. This impact can cause emotional distress, feelings of sadness and frustration, discouragement, guilt , and other emotions. This is what we know as the presence of depressive symptoms. In some cases, these depressive symptoms are so intense and persistent that they can lead to a diagnosis of depressive disorder.
Emotional self-regulation in psychotic disorders
Several studies highlight that more than 40% of people with a psychotic disorder also have a depressive disorder (Bosanac, and Castle, 2012; Kim et al., 2020, Sönmez et al., 2013; Upthergrove 2017).
This percentage varies depending on the stage of psychosis the person is in:
- It occurs in 60% of people in a phase of acute psychosis episodes.
- It occurs in 50% of people after the first psychotic episode.
- It occurs in 20% of people with chronic psychotic disorders.
Depressive symptoms in psychosis can therefore appear at different stages of the disorder and can have serious consequences, such as a higher probability of hospitalization, a greater risk of relapse, and a lower quality of life.
How do the symptoms of depression manifest in psychotic disorders?
- Depression doesn't manifest itself the same way in everyone, but some of the most frequent symptoms are:
- Sadness and hopelessness.
- Loss of interest or pleasure in activities that were previously enjoyed.
- Weight changes (loss or gain).
- Insomnia or hypersomnia (sleeping too much).
- Tiredness and loss of energy.
- Feelings of worthlessness or guilt.
- Psychomotor agitation or slowing.
- Cognitive difficulties, such as concentration problems, memory loss, or slowness in processing information.
- Recurring thoughts of death or suicidal ideation.
Factors associated with depression in psychosis
According to the study by Kim et al. (2019), depression in people with psychosis is related to several factors, which vary according to the phase of the disorder.
In the acute stage of the first psychotic episode (when symptoms first appear), depression is associated with:
- A longer period of untreated psychosis.
- Stories of childhood trauma (physical or sexual abuse).
In the stabilization phase (after treatment of the first episode) , depression is more related to environmental factors such as:
- Low income.
- Little family cohesion and support.
- Problems with sexual health.
These findings suggest that depression in psychosis does not have a single cause , but rather depends on both biological factors and the person's experience and environment.
Depression can affect motivation and make it difficult to adhere to treatment. It can also increase the risk of suicide, which is up to 20 times more frequent than in the general population, especially during the first five years after the onset of psychosis, considered a critical period. Furthermore, it can have a direct impact on quality of life and recovery.
In both psychosis and depression, proper support and treatment can make a significant difference in a person's quality of life.
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