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Psychotic Depression in Children and Adolescents


Updated October 17, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

There are different subtypes of depression in children. One severe subtype is known as psychotic depression. It involves the typical symptoms of depression with accompanying psychosis, or a loss of touch with reality. This can involve:

  • Auditory hallucinations (hearing things that did not occur)
  • Visual hallucinations (seeing thing that do not exist)
  • Delusions (false sense of reality)
  • Paranoia (feeling that people or things are watching you or out to get you)

The Course of Psychotic Depression

Typically, psychotic depression indicates a more severe course of depression, and is thought to indicate that the child has a more significant biological vulnerability to depression. However, with treatment, the likelihood of serious consequences decreases.

Psychosis is also seen in other disorders, such as bipolar I disorder, schizophrenia, and certain personality disorders. Psychotic depression is thought to be a risk factor for developing bipolar I disorder.

Additionally, the risk of a child developing psychotic depression has been associated with a family history of bipolar disorder and psychotic depression.

It is important to know that certain substances or physical illnesses can lead to psychosis. Only a trained professional can evaluate your child and determine the cause of her symptoms.

Treatment Options

Psychiatric treatment is always required for psychotic depression in children. Antidepressant medications, often in combination with antipsychotic medications, are shown to be effective for psychotic depression in children. In severe or resistant cases, electroconvulsive therapy (ECT) may be an option.

Psychotherapy treatment may be difficult in children experiencing severely psychotic depression, although as symptoms improve, so do the benefits of therapies like cognitive behavioral and psychodynamic psychotherapy.

If your child is depressed and has psychotic symptoms, it is important to speak to her pediatrician for evaluation. Depression is a serious medical illness, which requires treatment for the best possible outcomes.


Boris Birmaher, MD, David Brent, MD, et al.Practice Parameter for the Assessment and Treatment of Children and Adolescents With Depressive Disorders. The Journal of American Academy of Child and Adolescent Psychiatry. 46(11). November 2007. 1503-1526.

Depression and Suicide in Children and Adolescents. Surgeon General's Health Report. Accessed: March 10, 2011. http://mentalhealth.about.com/library/sg/chapter3/blsec5.htm

Meen Vythilingam, M.D., Joyce Chen, B.S., Bremner, J. Douglas, M.D. et al. Psychotic Depression and Mortality. American Journal of Psychiatry. 2003; 160: 574-576.

What are the Different Forms of Depression? National Institutes of Mental Health. Accessed: March 10, 2011. http://www.nimh.nih.gov/health/publications/depression/what-are-the-different-forms-of-depression.shtml

  1. About.com
  2. Health
  3. Depression
  4. Who's at Risk?
  5. Age Groups
  6. Child Depression
  7. Types of Depression
  8. Psychotic Depression in Children

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