Why do hallucinations appear in depression?

Why do hallucinations appear in depression?

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We all know the stories of people who saw a miracle in the deepist troubles like gangsters who turned to faith - or an older example could be the miracles in jail in the Bible (Acts: Peter and Paul).

How wide-spread is the phenomenon where people expierence hallucinations in a depressing situation? What is the neurological cause? And what hormones (neurotrasmitters) participate on this phenomenon?

Please concentrate on the neurological point of view, rather than on the psychological aspects.

Thank you.

Have a look at The God drug DMT. It causes people to see/talk to God and can be taken as an actual drug, but I believe it is also produced in the body during near death experiences. I am no expert in it but here's wikipedia:,N-Dimethyltryptamine

6 Common Hallucinations and What They Tell Us

It may seem so real: that nasty smell of urine floating by, or the feeling of bugs crawling up your arm. The people around you aren't experiencing it, which seems impossible. But actually, you're experiencing a hallucination.

People who hallucinate typically see, hear, feel, smell or otherwise experience things that simply aren't real. Sometimes, these sensory fake-outs are caused by something temporary or minor, but often, a pretty serious underlying medical factor is at play.

Even when the cause of a particular hallucination is often possible to pinpoint, scientists still struggle with understanding how the brain produces them. Recent strides were made when a 2019 study in mice discovered that hallucinogenic drugs cause activity in the visual cortex of the brain to slow way down, rather than speed up as was previously hypothesized. The researchers also found out that the visual cortex was receiving the same visual information that it would in absence of the drugs but was unable to interpret it correctly. This is a big deal because some mental health disorders, like schizophrenia, are strongly linked to the same receptors the researchers looked at, so a better understanding of how they work could someday produce more effective treatments.

Check out these common hallucinations to learn why they happen. If you're experiencing any of them regularly, be sure to talk to a doctor.

1. Skin Crawling

Ever felt like bugs were crawling all over you, with nary an insect in sight? The feeling that your skin is crawling is a form of tactile (touch) hallucination. Another version is the sensation of movement within the body, like organs shifting around, or that something inside is trying to get out.

There are a couple of things that can cause a tactile hallucination. Certain medications that affect the central nervous system, as well as other meds that impact neurotransmitters, are associated with the unpleasant experience. Alcohol and drug abusers, particularly those who partake in cocaine or amphetamines, are also likely to have tactile hallucinations.

Medical conditions are also a serious culprit, with more than 50 percent of schizophrenia patients surveyed in 2016 reporting that they had experienced tactile or visual hallucinations. Neurological disorders like Alzheimer's disease, Parkinson's disease and Lewy body dementia also are connected with tactile hallucinations. People dealing with severe instances of such hallucinations are often directed to cognitive behavioral therapy to help them manage the emotional fallout.

2. Hearing Voices

People who hear sounds, such as voices, that aren't actually there are dealing with auditory verbal hallucinations (AVH). Such voices can run the gamut from positive to negative and everywhere in between. Sometimes, the "voices" issue commands, but other times it's just a constant commentary, often described as a "radio station in my head."

Seventy percent of people with schizophrenia report having AVH phenomenon. But AVH doesn't only affect these patients. Those with bipolar disorder, some types of dementia, epilepsy, post-traumatic stress disorder and substance abusers are also at risk. AVH is actually more common than most people realize, and isn't always associated with mental or other illness. In fact, it's not uncommon for grieving people to hear the voices of recently departed loved ones. The reasons for AVH are unclear but scientists think it has to do with a disfunction among the frontotemporal regions of the brain. These are the regions of the brain involved with language, memory and emotional responses.

3. Smelling an Odor

Olfactory hallucinations (also called "phantosmia") occur when a person smells something that isn't there. Most of the time, the odors are nasty, like feces, smoke, vomit or urine. Unfortunately, this usually happens when the olfactory system has sustained some sort of nerve damage, whether by trauma, virus, drug or toxin exposure or even brain tumors. Epilepsy is another known cause.

4. Seeing Lights or Beings

Visual hallucinations include seeing people, lights or patterns that no one else can spot. This is the most common type of hallucination for dementia patients, although people with delirium (disturbance of consciousness) also experience it. Once again, people with schizophrenia, dementia, drug abuse or Parkinson's disease are also adversely affected (starting to see a pattern?)

Additionallly, people often report flashing lights and/or patterns during migraines, which is yet another way to experience a visual hallucination. This can also can occur during epileptic seizures. People who experience sleep disturbances, such as insomnia or narcolepsy, are also at added risk.

Visual hallucinations may be caused by a problem in a person's brain structure, a malfunction of the brain's neurotransmitters, traumatic past experiences or a combination of these. Whatever the cause, it's important to figure it out, as treatment really depends on whatever is inspiring them to occur. If the wrong treatment is given, it'll make things worse, not better.

5. Floating or Flying

This is called a proprioceptive hallucination, or a hallucination of posture. People who experience such an event report that they feel like they're flying or floating, but sometimes like they're in a whole different place from their actual body (known as an "out-of-body experience").

These experiences can be caused by sensory deprivation or overload, drugs (particularly hallucinogens) and even strong G-forces, like those that astronauts and pilots encounter. They can also spontaneously occur thanks to other factors, like extreme physical exertion, near-death experiences or sleeping lightly during times of stress, sickness or noise. Parkinson's disease patients, in particular, are known to experience this type of hallucination.

6. Metallic Taste

People who experience a gustatory hallucination typically report an unpleasant, often metallic, taste in their mouth without any influence from food or drink. Although most people head to dental professionals for answers, these taste bud changes are rarely discoverable there, but are instead caused by things like head injury, virus, schizophrenia and systemic allergies.

A litany of medications can also account for this taste problem, including such commonly used options like aspirin, penicillin and Vitamin D.

Research has shown that childhood trauma, whether it be bullying, neglect, emotional/physical/sexual abuse are linked to psychosis and hallucinations. In fact, people who experience severe sexual abuse as children are two to four times more likely to wind up with an adult psychosis diagnosis.

Psychologist’s Reply

You are describing behaviors and symptoms commonly found in both depression and psychosis. You are also experiencing panic attacks and perhaps episodes of depersonalization. When so many symptoms are present, ranging from explosive anger to auditory hallucinations, it’s important to look for general themes in the symptom display. There is a general theme here.

All of your symptoms have a common foundation. All are symptoms of changes in your neurochemistry. Some of these neurochemical changes may be significant, as suggested by your auditory hallucinations. In these situations, with multiple symptoms in several areas, I must recommend a psychiatric consultation. A psychiatrist is best trained to tease out the symptoms and identify what forms of treatment are best for your symptoms.

Importantly, psychologists and psychiatrists can’t read minds. You’ll need to accurately report all your symptoms (rage, sadness, hallucinations, etc.) and respond to questions. Professionals can only work with your case as you present it. This holds true of medicine, law, accounting, etc. If you only provide half the information needed — you’ll only receive one-half the benefit of the professional’s skills and services. Following your assessment, you may be referred for additional treatment such as counseling/therapy. It’s very important that you begin this evaluation and treatment process as soon as possible. If untreated, your symptoms can become worse.

How Geometric Hallucinations Are Generated in the Brain

This article is based on a lecture delivered by Professor Jack Cowan at an event entitled ‘A Discussion on Scientific Research with Psychedelic Drugs’ (the conference was chaired by Professor David Nutt at Imperial College London, 12/06/2013).

There are many causes of geometric hallucinations, including:

  • Flickering lights (a phenomenon which the scientist Jan Evangelista Purkinje investigated)
  • Anaesthesia
  • Hypnagogia (For more about this see my other article)
  • Near-death experiences
  • Entoptic phenomena (these are visual effects whose source is within the eye or brain itself – you can see entoptic phenomena when you press into your eyes…although don’t do it too hard!)
  • Psychoactive drugs
  • Various conditions such as migraine and epilepsy
  • Sensory deprivation

Professor Jack Cowan says that two of the most inspiring intellectuals he has studied have been Claude Shannon (known as the “father of information theory”) and Alan Turing (known as the father of computer science and artificial intelligence). One paper which influenced Cowan’s model of how geometric hallucinations occur is his Turing’s 1952 paper, The Chemical Basis of Morphogenesis. In this paper, he shows how the stripes on a tiger and the spots on a leopard can naturally occur. These patterns are the result of the interaction of two chemicals that spread throughout a system, like how a gas spreads throughout a box. The difference, however, is that the chemicals, which Turing calls morphogens, spread at different rates. One can be seen as the activator which expresses a particular quality (e.g. a blob or a stripe) and the other can be seen as an inhibitor (preventing the particular quality from being expressed).

Whether this explanation for patterns in nature is valid remains to be seen. Some say it is a bit too simplistic. In any case, Cowan argues that this Turing mechanism of diffusion and inhibition can be used to explain how visual geometric hallucinations result from brain activity. If neurons can be described mathematically in terms of “activators” and “inhibitors”, then that could explain why we see recurring patterns when we hallucinate.

Cowan believes that we should keep R. Mourgue’s (1932) words in mind: “The hallucination…is not a static process but a dynamic process, the instability of which reflects an instability in its condition of origin.”

The random fluctuations in brain activity might technically be “noise”, but even if it is, the brain still manages to transform it into a pattern. But how? Cowan says it’s all to do with the physical structure of the brain. With eyes closed, since there is no external input, the geometric hallucination should reflect the architecture of the brain more specifically, the architecture of the visual cortex. The brain can generate geometric hallucinations out of an unstable state because the architecture of the primary visual cortex (V1) exhibits symmetry (see diagram below). There is evidence that the orientation columns (which display a shift-twist symmetry) and the interconnected modules or hypercolumns (which display a lattice symmetry) can create geometric hallucinations when appropriately stimulated.

The architecture of the brain is also fractal by nature – the same patterns are repeated at different scales of size. This could, therefore, explain why fractal hallucinations are reported by those who take psychedelic drugs. Medical researcher Robin Carhart-Harris has commented on this, saying: “Like tree branches, the brain recapitulates. You are not seeing the cells themselves, but the way they’re organised – as if the brain is revealing itself to itself.” So, if you ever start hallucinating fractal geometry, that means you’re getting a good look at how your brain is structured.

Professor Cowan goes on to discuss cave art and how some of the geometric patterns drawn on the cave walls are signs of hallucinations. He refers to the work of archaeologist David Lewis-Williams who, in his book The Mind in the Cave, argues that the blob, dot and lattice patterns in the Chauvet cave are hallucinatory in nature. He argues that the hallucinations could have been the result of being in a dark cave with a flickering light, such as a fire. It has already been established by scientists, such as Purkinje, that a flickering light is capable of producing geometric hallucinations.

Cowan then goes on to discuss entoptic forms (Tyler, 1978) which are the basic visual patterns that come from the eye or brain itself. Lewis-Williams claims that entoptic forms can be found in San Bushmen rock art and Paleolithic rock art. Funnel and spiral images generated by LSD were studied by Oster (1970), whose study was based on his own experiences, and by Siegel (1977), whose study was based on the experiences of his subjects. The images they produced were extremely similar, suggesting that the geometric hallucinations generated by LSD are universal, and can, therefore, be attributed to an identifiable process in the brain. Just as Carhart-Harris has argued, hallucinating geometry is the experience of seeing the structure of your brain.

Heinrich Kluver, in Mechanisms of Hallucination (1942), organised entoptic forms into 4 classes which he called form constants. According to Kluver, all geometric hallucinations should fit into one of these categories. They are (1) Tunnels and funnels, (2) Spirals, (3) Lattices, honeycombs and checkerboards, and (4) Cobwebs.

A 1959 research paper by David Hubel and Torsten Wiesel found that there were neurons specialised for the detection of lines, orientation, corners and edges in the brains of cats. The famous neurologist and psychiatrist Oliver Sacks suggests in his book, Hallucinations (2012), that if these neurons in humans are stimulated by a psychedelic drug, geometric hallucinations can be generated.

What’s the Difference Between Delusions and Hallucinations?

Delusions and hallucinations are altered perceptions of reality that feel very real to the person experiencing them.

People with schizophrenia often face significant stigma, partly due to how certain symptoms manifest. Still, myths that people with schizophrenia are dangerous are false and harmful.

In fact, according to the Mental Health Foundation, most people with schizophrenia are not violent, and are actually more likely to harm themselves or be a victim of violence.

Schizophrenia is a challenging but treatable chronic mental health condition that affects about 20 million people worldwide.

Learning about schizophrenia and its symptoms — like delusions and hallucinations — can help you explore treatment options for yourself or a loved one.

People with schizophrenia sometimes experience hallucinations or delusions. These are both altered perceptions of reality, but they feel very real to the person experiencing them.


Hallucinations are when a person has a physical sensation, sees, or hears something that’s not actually occurring.

Some people may see things or hear voices that others don’t. Other people may smell things that others aren’t able to, or feel things on them.


Delusions occur when a person strongly believes something that isn’t based on reality even when shown evidence.

People can experience a range of delusions.

For example, some people experience paranoia, believing that someone is following them or trying to hurt them. Others believe that someone is controlling their thoughts or listening in on what they’re thinking.

Some people may also experience delusions of grandeur, which is when someone believes they’re famous or have special abilities, or a special connection with someone or something important.

While schizophrenia can happen at any age, onset usually occurs during late teens to early 30s.

Schizophrenia tends to affect males and females equally, but may occur earlier in males.

While it’s rare for the condition to be diagnosed before age 12 or after age 40, one study says that 20% of people with schizophrenia have “late-onset schizophrenia” which is diagnosed after age 40.

Schizophrenia tends to cycle in stages. During the early stage, there may only be small behavioral changes that gradually get more concerning or noticeable.

Early signs of schizophrenia include:

  • isolating more
  • difficulty completing tasks like school work
  • increased irritability
  • sleep issues

Past the early stage, symptoms of schizophrenia usually fall into three main categories:

Positive symptoms

Positive symptoms of schizophrenia are behaviors not typically seen in people without the condition.

These behaviors may include:

  • hallucinations
  • delusions
  • unusual body movements like repeating certain movements or being unresponsive (also known as catatonia)

Negative symptoms

With schizophrenia, negative symptoms are behaviors or emotions that are notably absent.

Negative symptoms include:

  • withdrawing from other people
  • seeming “flat” or lacking emotional expression
  • showing little interest in activities or pleasure
  • being unable to start or complete activities

Some of these symptoms can be confused with symptoms of depression.

Cognitive symptoms

Cognitive symptoms affect memory and thinking. People with schizophrenia may have trouble organizing their thoughts or completing tasks.

Cognitive symptoms include:

  • difficulty thinking clearly or paying attention
  • lack of insight about their mental health conditions (i.e., they may not think they have a problem)
  • trouble processing information and using it to make decisions

Even if you’re experiencing one or more of these symptoms, only a medical professional can accurately diagnose schizophrenia.

Delusions and hallucinations are so-called positive symptoms of schizophrenia — behaviors often not seen in people who don’t have the condition. Both symptoms involve altered perceptions of reality.

Hallucinations are mainly connected to a person’s senses, so they may hear, see, smell, or feel something that’s not really there. Delusions occur when a person strongly believes something that isn’t based on reality.

While only a mental health professional can diagnose schizophrenia, you can take this quiz if you want to see if you have any signs of the condition.

If you think you or someone you know may have schizophrenia, it’s important to seek help. Treatment options like therapy and medication can help you live well and manage your symptoms.

Living with schizophrenia may feel overwhelming at times, but you’re not alone. With the right treatment team and supportive allies by your side, successfully managing your condition is possible.


Hallucination is a fundamental symptom in psychiatry. Two hundred years of research into this phenomenon has not yet answered the following questions:

Whether hallucinations are pathognomic of psychosis or not?

Whether the presence of hallucinations (as such or in different modalities and forms) can include or exclude certain diagnoses or not?

What is the neural substrate of hallucination?

These questions are very basic to the understanding of mental diseases and more research in both the phenomenological and the theoretical areas is necessary to unfathom the secret.

Conventionally, hallucinations are treated as psychotic features. However, there is ample evidence to support hallucination in non-psychotic conditions. The mechanism and nosological status of these conditions are not yet clear. Assessing the cultural background in the evaluation of hallucination is important as the concept of reality varies across cultures and there is a possibility of culturally sanctioned hallucination. Apart from effective pharmacological treatment, a greater awareness is needed regarding the psychological treatment of hallucination, which can help us deal with refractory hallucinations.

Signs of Major Depression Subtypes: Psychotic Features

Yesterday, we got reacquainted with Major Depressive Disorder (MDD) in general. Today, we will start looking at the subtypes, or specifiers, beginning with Psychotic Features. Estimates vary, but psychotic depression seems to be present in upwards of 20% of MDD patients and bring new challenges to treatment. Unfortunately, Psychotic Features are correlated with worse prognosis and morbidity, yet according to a top researcher on the topic, often go unrecognized (Rothschild et. al, 2008 Rothschild, 2013).

A Review of Psychosis:

Psychosis is a word that stems from the Greek psy, meaning &ldquoof the mind&rdquo and osis, meaning &ldquoabnormal condition of.&rdquo The word essentially equates to &ldquoout of touch with reality.&rdquo This is most associated with Schizophrenia, but psychotic symptoms occur across numerous disorders. While it is the primary feature of diseases in Schizophrenia spectrum disorders, we may see delusions, hallucinations, and/or disorganized psychotic symptoms in depression, mania, some personality disorders, PTSD, and even some severe OCD presentations can have delusional material. Psychosis is also present in dementia and delirium.

While sometimes it will be obvious that the patient is experiencing psychosis, like talking to themselves and looking about, in other instances it may be more subtle. Perhaps the patient, &ldquohas it together enough to know they don&rsquot have it together&rdquo and are able to hide it. After all, they&rsquore feeling bad enough being depressed, why would they want to let on that they&rsquore &ldquocrazy,&rdquo too? This is where the clinician becomes detective.

First, it is always a good idea to ask any new patient during their diagnostic interview about psychotic symptom experiences, even if it is not a presenting complaint. Cover your bases! Remember, patients don&rsquot necessarily know what hallucinations and delusions are, so don&rsquot point-blank ask, &ldquohave you ever hallucinated or had delusions?&rdquo


Hallucinations are internally-generated sensory experiences. The person&rsquos mind is creating voices, sights, tastes, smells and sensations. Most common are voices, followed by visual hallucinations. Some common hallucinations experienced by patients prone to them during Major Depressive episodes include:

  • Voices saying demeaning things like &ldquoyou&rsquore no good and no one likes you!&rdquo
  • Commands to hurt themselves
  • Seeing demons or dark characters
  • Seeing and smelling rotting flesh on their body

The examples above are known as mood congruent hallucinations- they are related to the theme of depression. Some people experience mood incongruent hallucinations. An example of mood incongruent hallucinations during MDD would be voices telling the person positive things about themselves, or that they have superpowers. Mood incongruent psychotic features are associated with poorer prognosis. While it&rsquos merely a hypothesis, perhaps mood incongruent hallucinations are the subconscious&rsquo way of trying to correct the depressed mood. Diagnostic protocol dictates that we not only note if Psychotic Features are present, but also if they are mood congruent or incongruent.

Assessing for hallucinations

To assess for hallucinations, a clinician might pose the question like this: &ldquoWhen you&rsquore awake, has anything ever happened where you thought you were experiencing, or maybe you were even sure you were experiencing, hearing or seeing things that other people couldn&rsquot?&rdquo

I preface with &ldquowhen you&rsquore awake&rdquo because some interviewees, when I&rsquod ask when the voices occur, replied, &ldquowell, in my dreams.&rdquo I also find it important to ask if it sounds like their own voice, such as hearing themselves think, or if it sounds like someone is speaking to them but nobody is there. More than once, it was clarified &ldquohearing voices&rdquo meant their own train of thought.

If the patient says they have experienced hallucinations, a clinician can respectfully dig deeper by replying : &ldquoThanks for willing to share that with me. I know it might not be easy to talk about. Can you tell me whenthe last time the voices (or seeing things, etc) happened?&rdquo Be sure to ask if they may occur any time, or, if the person is prone to depression, only during the times they&rsquore depressed. If hallucinations (and/or delusions) are reported as occurring regularly regardless of mood, then it could be more indicative of a Schizophrenia-spectrum condition.

Next, I like to follow up: &ldquoWhat can you tell me about the experience?&rdquo and let the patient fill you in rather than making them feel interrogated about it. It is often embarrassing for patients to admit to such things, and we don&rsquot want them to shut down. Rather, partner with them to learn about the experience and show you want to understand, because, there&rsquos a good chance they&rsquove felt entirely misunderstood if they have tried to share the experience before.

Lastly, be sure to clarify if the hallucinations ever include commands to harm themselves or others and if so, have they ever acted on them? How do they deal with such voices if they arise? Have they had any such voices today? If so, be sure to perform a risk assessment.

In the end, there is no need to panic if someone says they hear voices. Many people do and have learned to manage them well, sans medications. Exploring that further is part of our job as treatment providers.


A delusion is a fixed, false belief that is held with conviction. In other words, even if everyone else knows the belief is not true, the patient is convinced of it. Some examples of mood-congruent delusions include:

  • The patient to begins believing they are a &ldquoblack angel&rdquo and friends and family must keep their distance, or they&rsquoll contaminate them, and they&rsquoll die. Such a delusion is likely rooted in intense guilt of being burdensome to others and negative feelings towards themselves to the point they feel evil.
  • The patient is not sure if they are alive or dead. This is called a nihilistic delusion.
  • They feel they are such a bad person that they deserve punishment and are sure people are following them to ambush them at the right time a sort of paranoia.
  • They feel they are an awful husband or wife, and therefore believe their spouse must therefore cheating on them.

Can you come up with some examples of what mood-incongruent delusions may be in a depressed patient? Feel free to share in blog comments!

Assessing for delusions

Assessing for a history of delusional material can be a bit trickier than hallucinations, because delusions can take on so many forms and themes. If someone is not clearly delusional that again does not mean we shouldn&rsquot try to assess for a history of the matter. We can test the waters with inquiries such as, &ldquoAt any point, did you ever fear things were happening in your life that you just couldn&rsquot explain? Like, maybe you felt you were under surveillance, or that special messages were being sent to you from the TV or radio?&rdquo If yes, asking follow-up questions like the above, such as asking them to explain their experience, is the next step.

While it is a good idea to do some reality testing, it is not a good idea to become challenging towards a delusional patient, especially if they are paranoid. They could feel you&rsquore against them, too. Using the first example of the &ldquoblack angel&rdquo a clinician might reply, &ldquoHow did you discover this?&rdquo There is a good chance you&rsquoll get a rather detailed description, indicating this is their reality and the delusion is solidified for the time being. Others may choose to remain terse. Don&rsquot take it personally it can be embarrassing for the person to discuss. Like hallucinations, if you discover a patient has a delusion that may lead to harming themselves or others, be sure to perform a risk evaluation.

Treatment implications:

Clearly, the presence of delusions and/or hallucinations bring additional, significant challenges to treatment. It is not unusual for psychotically-depressed patients to require hospitalization, which you, as therapist, may be instrumental in organizing if they have a heightened risk to self or others. Even if a patient isn&rsquot psychotic at the moment, knowing if they have a history of becoming psychotic when depressed is important. At the first sign a depressive episode is setting in, it is a good time to encourage a visit to their prescriber to assess for use of an antipsychotic medication to augment their antidepressant and ride out the storm, nipping it in the bud.

It is all about prevention, if possible. Given therapists usually see their patients more often than other providers, they are the first to notice symptom onset and worsening severity, so are essential in advocating for and orchestrating adjunctive treatments to psychotherapy. If a patient indeed has a history of psychosis while depressed, it is essential to inquire about the symptoms each session.

Tomorrow&rsquos post will feature the Anxious Distress specifier, another addition to MDD that contributes higher risk of self harm.


First, you’ll get a physical exam and talk about your health history and symptoms. Your doctor might ask questions like:

  • What exactly are you seeing?
  • When did it start?
  • Does it tend to happen at certain times, like as you’re falling asleep?
  • Do you have any other symptoms when it happens?
  • Is what you’re seeing scary? Threatening? Pleasant?

This usually gives your doctor clear clues about what other tests you should get. For example, you might need to see a psychiatrist to check for a mental illness. Your doctor may also order certain blood tests. And you might get an:

    (EEG), which measures electrical signals in your brain, to look for signs of epilepsy to check for vision problems to look for a brain tumor

It all comes down to your symptoms and where that points you.

Psychotic Depression: Losing Touch With Reality

This severe type of depression can cause someone to see or hear things that are not really there. Could you be at risk?

You may be familiar with some of the symptoms of clinical depression — profoundly depressed mood, fatigue, and feelings of hopelessness. But did you know that depression may also be linked to psychosis?

The National Institute of Mental Health (NIMH) defines someone who is “psychotic” as out of touch with reality, likely experiencing false beliefs, known as delusions, or false sights or sounds, known as hallucinations. So when do depression and psychosis go hand in hand?

Psychotic Depression: What Is It?

"Psychotic depression is a relatively rare condition that occurs when someone displays both severe depression and a break with reality. The loss of contact with reality may take the form of delusions, hallucinations, or thought disorders," explains James C. Overholser, PhD, professor of psychology and director of clinical training at Case Western Reserve University in Cleveland.

Approximately 25 percent of people who have depression that is severe enough to cause them to be admitted to a hospital also have psychosis or psychotic depression. "Major depression with psychosis" is another term used to describe the condition of psychotic depression.

Psychotic Depression: Symptoms

The delusions or hallucinations of people who have psychotic depression often involve beliefs, voices, or visions telling them that they are worthless or evil. In some cases, people may hear voices telling them to harm themselves. In addition to these symptoms, psychotic depression may also cause the following:

  • Feeling persistently worried and on edge
  • Falsely believing you have other illnesses or diseases
  • Difficulty sleeping
  • Poor concentration

Psychotic Depression: Getting a Diagnosis

If you or a loved one has symptoms of psychotic depression, see your doctor right away. Your doctor will perform a medical examination and blood work to make sure your symptoms are not caused by a medical disease or a reaction to medications. A complete psychiatric evaluation will also be done to distinguish psychotic depression from other types of depression and from other psychotic disorders such as schizophrenia.

The cause of psychotic depression is not known, but having a family history of depression or psychosis increases the risk. One of the differences between psychotic depression and schizophrenia is that people with schizophrenia believe their hallucinations or delusions are real. In most cases, people with psychotic depression know their symptoms are not real. They may actually be afraid or ashamed to tell their doctor about these symptoms, which can make the disorder that much more difficult to diagnose.

Psychotic Depression: Getting Treatment

Antidepressants and antipsychotic drugs are often used to treat psychotic depression. "It is likely that psychotic depression has more of a biological basis [than other types of psychosis], and seems to respond more to biological interventions. Treatment usually requires a combination of medications," notes Overholser. Electroconvulsive therapy, or shock therapy, may also be effective in some cases.

A recent review of 10 studies involving over 500 patients treated for psychotic depression concluded that it may be best to start with an antidepressant drug alone and then add an antipsychotic drug if needed. Using an antipsychotic drug alone is not appropriate therapy. Treatment of psychotic depression is more likely to require hospitalization than other types of depression, and long-term medications may be necessary.

If you have symptoms of depression combined with hallucinations or delusions, don't hesitate to ask for help. It is particularly important to share the details of your symptoms with your doctor, because psychotic depression must be managed differently than other types of depression. The most serious risk of psychotic depression is suicide, so getting appropriate treatment as soon as possible is crucial.

Psychotic depression is an illness, not something to be ashamed of or a weakness. It is also a treatable condition, and most people recover within a year.

Hallucination Causes and Anxiety

Anxiety can play tricks on the mind, and anxiety itself can cause you to fear or think the worst about issues that are otherwise fairly normal. Severe hallucinations, especially visual hallucinations, are extremely rare for those with anxiety, but that doesn't mean that there aren't similar and related hallucinations that are attributed to anxiety symptoms.

Make sure you've ruled out other issues. Drug abuse can cause hallucinations, for example.

While it's always a good idea to visit a doctor or psychologist if the hallucinations are strong, the reality is that those who are truly hallucinating from some type of mental health problem rarely have enough of a grasp on reality to recognize it's a hallucination. Those who are genuinely hearing voices or seeing things that aren't there usually suffer from such intense reality loss that they are unaware what they're seeing isn't really there.