Psychotic depression: How to diagnose this often undetected — and hidden — condition

Major depressive disorder with psychotic features, commonly referred to as psychotic depression, is a diagnosis that often goes undetected in children, adolescents, and adults alike. One of the most challenging aspects of this disorder is that the patient's delusional pattern of thinking can be subtle in nature, increasing the likelihood that the underlying psychotic component to their presentation will be overlooked by even the most skilled clinicians. Moreover, studies have shown that once patients have been successfully treated for an episode of psychotic depression, they often reflect back to their illness and express having felt reluctance to reveal the extent of the paranoia and delusions they were experiencing due to fear of being labeled as “crazy,” adding an additional degree of difficulty in diagnosing and, ultimately, treating that patient.