What happens when a depressed person loses touch with reality, the cause may be a serious condition called Psychotic Depression. Psychotic Depression occurs when a person with severe depression also experiences psychosis, characterized by hallucinations that involve seeing or hearing things that don't actually exist, as well as delusional thoughts, which most often entail various irrational beliefs, thoughts and fears. The subject matter of hallucinations and delusions often reflects the sufferer's depressed mood. For example, people with Psychotic Depression may see frightening images such as an apparition of the devil, hear voices that insult them, or that urge them to harm themselves or others. People with Psychotic Depression may also: think they're dying of a serious medical illness; become unreasonably distrustful, often believing that others "hear" their thoughts or want to kill them; or believe themselves to be a famous person or guilty of a crime they didn't commit. Other symptoms of Psychotic Depression may include anxiety, insomnia, poor concentration, sudden outbursts of anger, constipation, physical immobility and extreme self-neglect. Psychotic Depression typically requires immediate medical attention, because sufferers may be unwilling or unable to take care of themselves, as well as to prevent self-harm or harm to others. Approximately one-fourth of people who are admitted to the hospital for depression suffer from Psychotic Depression. While the exact cause of Psychotic Depression is unknown, research shows an association with elevated levels of Cortisol, a hormone produced in large quantities during times of significant stress. With Psychotic Depression, natural Cortisol production may be off kilter, leading to psychosis. And, while no specific risk factors for Psychotic Depression have been identified, people who have a family history of depression are more likely to be affected. Unlike other types of mental illness involving hallucinations and delusions, like schizophrenia or bipolar disorder, sufferers of Psychotic Depression are often aware that the things they see and hear are not real. This may result in embarrassment and attempts to hide symptoms, making diagnosis difficult. The first step in diagnosing Psychotic Depression often involves seeing a doctor for a physical exam and blood tests to rule out any medical conditions or drug reactions that could be causing the symptoms. It is also essential to have a complete mental health evaluation to differentiate Psychotic Depression from other mental disorders that cause breaking with reality, and from other types of depression. This is because treatment differs from other depressive illnesses, and risk of suicide is greater. Psychotic Depression can be treated successfully. However, it is not as responsive to psychotherapy as other forms of depression. Also, antidepressants alone are typically not sufficient. As a result, treatment generally involves a combination of antidepressants and antipsychotic drugs to effectively control symptoms. ECT (electroconvulsive therapy) may be used and can be very effective. But it typically is only used to treat extreme conditions that have not responded to other courses of treatment. Most people recover from Psychotic Depression within a year. However, it's often necessary to continue the medication regimen and receive ongoing professional follow-up, as the risk of depressive symptoms returning is higher than a return of the psychotic symptoms. If you think you or someone know may be suffering from Psychotic Depression, please consult your doctor or a mental health professional.