Mandy Kloppers

Psychotic Depression


Psychosis involves delusions, hallucinations and incoherent behaviour. When someone is experiencing a psychotic episode, they lose their connection to reality and experience delusions which as mistaken beliefs and hallucinations which involve seeing or experiencing something that does not exist in reality and only exists in the person’s mind. The person experiencing these episodes will believe that their delusions and hallucinations are real.

It can be extremely confusing and frightening for the person experiencing the psychotic break as well as for their family who is often at a loss as to what to do for the best.

Psychosis can emerge without depression but when depression is also present, it is known as psychotic depression. One of my clients came to see me out of sheer desperation as his wife had experienced a psychotic episode and had become convinced that he was trying to kill her. Of course, this wasn’t happening in reality but she nevertheless became extremely frightened of him and refused to stay in their home alone with him. She would lock herself in the bathroom and refuse to come out. Eventually, she was sectioned for her own safety and was obviously angry at her husband and felt he was doing this as part of his ploy to harm her.

She acted completely out of character and told her husband and their children that their dog had the answers. When they asked her what she meant she nonchalantly explained that “dog” was “God” backwards and their dog was holy.

This gives an idea of what psychosis can do and how divorced from reality a person can become. Psychosis can be dealt with effectively with antipsychotic drugs such as Halperidol, Chlorpromazine and Clozapine.

People with psychotic depression may also experience psychomotor agitation – an inability to relax or sit still. They may rock, fidget, or move their legs a lot, for example. Being acutely and severely anxious, often as a result of the symptoms of psychosis, contributes to psychomotor disturbance.

The estimated numbers of people who are likely to experience severe clinical depression at some time in their lives vary between three and 11 people in every 100. Women are twice as likely than men to develop depression “ so two-thirds of people who have severe clinical depression will be women.

Not everyone who has severe clinical depression will experience psychosis. Approximately 10 to 15 per cent of people will at some stage go on to develop the symptoms of psychosis.

Researchers do not know why some people develop psychosis, and others don’t develop hallucinations and delusions. They are therefore unable to predict which people who have depression will experience the symptoms of psychosis.

How to deal with an active psychotic episode

  • The key is to be caring, gentle and non-judgemental. Find somewhere where they can talk safely and that’s free from distractions. Let them know you’re worried about them, but avoid talk of mental illness or diagnoses “ you could be wrong and it might just make them more frightened. Don’t force a conversation if its not wanted and don’t touch them without permission.
  • Ask the person what will help them feel safe and in control, and allow them to talk about their experiences at their own pace, even if they seem quite unusual to you. Let them know that help is available, and if they don’t want to talk, they’re welcome to talk at a later time.
  • Its important to respect the person’s beliefs, even if you don’t agree. Someone who is experiencing psychosis might find it hard to distinguish what’s real from what’s not, so telling people that they’re wrong rarely helps. However, its always possible to empathise with whatever emotions are stirred up by the experience and this can be very comforting.
  • Avoid criticising or blaming the person. They may be talking or behaving differently because of their experiences. Although the person might be having some odd experiences and difficulty focusing, their intelligence is unlikely to be affected, so you can talk to them as any other adult. However, sarcasm might be misunderstood by someone who is very suspicious, so should be avoided. Be honest, and don’t make promises you can’t keep.


Learn first aid for psychosis