Can Psychotic Depression Turn Into Schizophrenia?

Depression and schizophrenia are two very different disorders, but there is some overlap between them. In fact, up to 50% of people who are diagnosed with schizophrenia also have symptoms of depression.  

Schizophrenia is a serious mental illness that can affect anyone at any age. In this article, you will learn how schizophrenia and depression are linked, and the treatment you can pursue to feel better. 

Also read: How Do I Talk To Someone About My Depression Or Anxiety?

What is Depression?

Depression is a pervasive mood disorder, affecting people of all races and socioeconomic strata. 

With depression, people often feel sad, down, or hopeless. They might lose interest in things they used to enjoy, have trouble concentrating, feel lethargic or exhausted, and have changes in their appetite or weight. People with depression may also have sleep problems, feel irritable, and experience headaches or other physical symptoms. With schizophrenia, people might also experience some of these symptoms, but they're likely to have more severe symptoms.

Women are twice as likely to experience depression as men, and people with lower socioeconomic status are much more likely to develop depression than those with higher incomes. Additionally, research shows that having a family history of depression increases your risk of developing it yourself; if you have an older sibling who was diagnosed with Major Depressive Disorder before age 18, you have a 34% increased chance compared to someone without such an older sibling.

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What Is Schizophrenia?

Schizophrenia is a disorder that causes a person to have difficulty distinguishing between what is real and what is not. The symptoms of schizophrenia include hallucinations, delusions, incoherence, and disordered thoughts and emotions. Schizophrenia affects about 1% of the population worldwide, and men are more commonly affected than women. People with schizophrenia symptoms may seem like they have lost touch with reality at times or have an unusual understanding of the world around them.

Schizophrenia is characterised by:

• Hallucinations (hearing voices or seeing things that aren't there)
• Delusions (believing something is true when it isn't)
• Disorganised speech patterns.
• A loss of interest in activities they once enjoyed
• Difficulty making decisions about what to eat or wear each day. 

The symptoms of schizophrenia can be broken down into three categories: positive, negative and cognitive.

• Positive symptoms include hallucinations (seeing or hearing things that aren't there) and delusions (believing something is real when it's not). These are the most distinctive features of schizophrenia.
• Negative symptoms include a lack of emotion and motivation, as well as difficulties with social interactions.
• Cognitive symptoms include problems with attention span and memory.

Schizophrenia can be treated with medication or therapy; however, it is not curable (though research continues). Treatment involves treating underlying conditions such as depression or substance abuse, along with antipsychotic medications if needed.

How Is Depression Diagnosed?

A mental health professional begins by exploring how long your symptoms have persisted, when they started, how frequently they occur, and how much they affect your daily routine. Depression is typically diagnosed when symptoms appear most of the day, nearly every day, for at least two weeks, with either a persistently low mood or a loss of interest and pleasure being central signs.

Since certain medical issues like thyroid imbalances, infections, or medication side effects can mimic depressive symptoms, your clinician may recommend a physical examination, an in-depth interview, and lab tests to rule out other causes.

Depression isn’t identified by sadness alone. It’s about how long the symptoms last, how deeply they interfere with your ability to function, and how frequently they occur. If you notice ongoing changes in sleep, appetite, focus, or energy along with a lasting low mood, seeking professional support can help you get the right diagnosis and start effective treatment early.

How Is Schizophrenia Diagnosed?

If you are diagnosed with schizophrenia, your psychiatrist will likely perform a physical exam and lab tests. In addition, it's important to tell them about any other mental health conditions that you may have had in the past. The psychiatrist may also ask about your family history of mental illness and addiction. Finally, ask if there's anything else the psychiatrist should know about your medical history or mental health treatment you’ve sought in the past (if applicable). 

If you are diagnosed with schizophrenia, your psychiatrist will likely perform a physical exam and lab tests. If your psychiatrist believes that you have suffered from psychotic depression, but that this condition has been resolved naturally without medication or therapy sessions, they will not diagnose schizophrenia as an alternative diagnosis 

Also read: How Technology is Changing Mental Health: The Latest Treatments for Depression, 2022

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The Difference In Treatment: Schizophrenia and Depression

When it comes to treatment, there are important differences between the two diseases that can make it difficult for psychiatrists and patients to distinguish between them.

Schizophrenia is related to a chemical imbalance in the brain; for example, it's often treated with antipsychotic drugs like haloperidol (Haldol). Psychotic depression is not caused by a biological problem in your body; rather, it's caused by an emotional or psychological trauma or stressor that triggers a reaction from your brain. This stressor could be something as simple as being fired from your job or having a bad breakup—it doesn't matter what triggered it, so long as you're feeling overwhelmed about something beyond your control.

Depression is typically treated with psychotherapy, which can include Cognitive Behavioural Therapy or Interpersonal Therapy. For more severe forms of depression, you might be prescribed antidepressants or antianxiety medications, depending on your symptoms. 

The good news is that both depression and schizophrenia can be treated effectively with medication and psychotherapy.

Also read: Depression Medication: How it Works and the Common Side Effects

What's The Difference Between Schizophrenia And Depression?

One way to tell them apart is by their symptoms. Schizophrenia usually manifests with delusions and hallucinations, while depression can cause feelings of sadness, worthlessness, and hopelessness.

Schizophrenia can also present with symptoms that are not typically seen in depression, such as catatonia (a state where a person remains motionless for hours) or paranoia (the belief that other people are conspiring against you). It's important to note that not all symptoms will be present in every person; it may be worth getting professional help if you suspect one or both conditions.

An experienced psychiatrist will use a physical exam and lab tests to distinguish between the two conditions. A mental health history might help determine if a patient has psychosis, but it's not always an accurate way to tell if someone has schizophrenia.

Can Psychotic Depression Really Turn Into Schizophrenia?

When a person experiences a severe depressive episode accompanied by hallucinations or delusions, it can feel deeply distressing. However, it’s essential to understand that major depressive disorder with psychotic features, or psychotic depression, is not the same as schizophrenia. While both conditions may share overlapping symptoms, they have distinct causes, patterns, and treatment approaches.

Psychotic depression does not necessarily progress into schizophrenia. Instead, untreated cases may increase the likelihood of developing or revealing another psychotic condition, such as schizoaffective disorder, where mood symptoms and psychosis coexist. In simple terms, depression with psychosis and schizophrenia belong to different diagnostic categories, and one does not simply transform into the other.

That said, the presence of psychotic symptoms during a depressive episode often signals a more complex clinical picture, requiring prompt and thorough evaluation. If these symptoms appear even when mood symptoms have improved, it may suggest a separate psychotic disorder and call for a revised diagnosis.

In summary, psychotic depression can make the illness more severe and raise the risk for other conditions, but it does not automatically lead to schizophrenia. Early detection and consistent treatment can significantly improve recovery outcomes.

It's natural to wonder if there's a link between schizophrenia and depression. After all, they both involve changes in mood, thinking, and behaviour.

The truth is that while there is a link between schizophrenia and depression, they are two different conditions.

It's important to know the difference between schizophrenia and depression and to get help if you think you might be suffering from either condition. If you're feeling suicidal or like you're losing touch with reality, get help right away.

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Frequently Asked Questions

Is depression a risk factor for schizophrenia?

While depression itself doesn’t cause schizophrenia, it can be a sign of underlying vulnerability to mental health conditions. People with recurrent or severe depression, especially with psychotic features, may have a slightly increased risk, highlighting the importance of early intervention and consistent treatment. 

What are the risk factors for psychotic depression?

Psychotic depression is more likely to occur in individuals with a family history of mood or psychotic disorders, high stress levels, trauma, or previous depressive episodes. Biological factors, such as hormonal or neurotransmitter imbalances, can also play a role in triggering psychotic features.

Can severe depression cause psychosis? 

Yes, in some cases, very severe depression can lead to psychosis. This form of depression, called major depressive disorder with psychotic features, involves delusions or hallucinations that are consistent with depressive themes like guilt, worthlessness, or hopelessness. Prompt psychiatric treatment is crucial.

Can depression evolve into schizophrenia?

Depression does not directly evolve into schizophrenia. However, untreated psychotic depression may later be reclassified if symptoms of psychosis appear outside mood episodes. Both conditions share overlapping features, so ongoing assessment helps ensure accurate diagnosis and tailored care.