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Delusional Depression Symptoms

4 Delusional Depression Symptoms And It’s Treatment

Writen By: Sana Ihsan
Reviewed By: Huma Khan
Publish Date: November 22, 2023

Have you ever wondered about a world where your own thoughts seem to tell a different story? Well, that sounds a lot like delusional depression symptoms. Imagine feeling really low about yourself, and then suddenly your mind starts throwing in some wild ideas, like doubting everyone around you. What if you start believing that someone is spying on you, is following you, or may want to kill you? You may think everyone around you really hates you, or worse, that you’re not worth anything. And here’s the tricky part: how do you even tell what’s real and what’s not when delusional depression symptoms blur the line? This is what we are going to talk about in detail.

Delusional depression is a mental health condition where individuals experience persistent feelings of sadness or worthlessness, coupled with distorted thoughts and beliefs. Unlike typical depression, delusional depression symptoms involve irrational ideas or beliefs that are not based on reality. It creates a challenging environment for the individuals going through this form of depression because, the majority of the time, they are unaware of the irrational nature of their thoughts, which makes it even more complex for them to separate genuine experiences from their false beliefs.

In this blog post, we’re diving into delusional depression symptoms, their causes, coping strategies, and insights from genuine research studies. Furthermore, we will clear up your confusion and explain the difference between delusional depression and other depressive disorders. At the end, we are going to answer some frequently asked questions about this topic. So, if you’ve got questions, then we’ve got some answers. Join us for a quick and easy read that aims to help you understand, cope with, and support others dealing with delusional depression symptoms.

What is Delusion?

A delusion is a powerful and persistent false belief that a person maintains despite overwhelming evidence or facts proving it to be untrue. These beliefs often deviate from reality, and individuals experiencing delusions typically find it challenging to accept or change these inaccurate beliefs, even when presented with contradictory information.

Mood-Congruent and Mood-Incongruent Delusions

Delusions are further classified into mood-congruent and mood-incongruent delusions, which are explained below:

Mood-congruent delusions are characterized by beliefs that align with the person’s current mood, even if these beliefs are extreme or irrational. For instance, during a depressive episode, someone might genuinely feel they are sinful and worthless. In a manic episode of bipolar disorder, an individual might have delusions of grandeur, believing they have special powers or are invincible.

Mood-incongruent delusions, on the other hand, involve beliefs that sharply clash with a person’s current mood or emotional state. For instance, someone experiencing a major depressive episode may believe they have an extraordinary ability, a belief inconsistent with the typical feelings of powerlessness and hopelessness associated with depression. Similarly, during a manic episode, someone might believe they are deeply guilty or responsible for catastrophes, which contradicts the elevated mood.

This 2012 study suggests that mood-congruent or incongruent delusions are associated with the severity of depression and an individual’s personality traits.

What is Delusional Depression?

Delusional depression, clinically referred to as Major Depressive Disorder (MDD) with psychotic features, is a subtype of depression. Delusional depression symptoms often go beyond feeling sad and extend into a realm of false or misguided perceptions and beliefs. These false beliefs can be intense and distressing, shaping your outlook on yourself and the world. It feels like navigating a reality where your mind creates a narrative that doesn’t align with the actual circumstances.

Delusional depression is often confused with other forms of depression due to some shared features. Many individuals suffering from this condition usually have one thing in common, and that is fear. They always fear something negative coming their way. This 2018 research also suggests that delusional depression is distinct from other forms of depression and is characterized by inhibition and fear. This research also suggests that treatment of fear with benzodiazepines may be effective.

This 2021 study suggests that delusional depression may be a form of melancholia, a distinct subtype of depression characterized by severe and non-reactive mood and psychomotor changes. This 2020 research further suggests that delusional depression is a severe form of melancholia characterized by psychomotor retardation, depersonalization, and depressive delusions. It arises from a fear of losing basic human values. 

Diagnosis of Delusional Depression

To diagnose delusional disorder, healthcare providers use the guidelines outlined in the DSM-5. The criteria include:

  • Presence of depressive symptoms before the onset of delusions. 
  • Experience of one or more fixed, false beliefs despite contrary evidence that often revolves around themes like guilt, illness, poverty, or inadequacy.
  • Duration of delusions for at least a month or longer
  • Absence of hallucinations or other psychotic features, as in psychotic depression
  • Absence of any other mood disorder symptoms
  • Absence of any lack of normal functionality

Prevalence of Delusional Depression

The specific statistics for people suffering from this condition cannot be specified, but it falls under the category of depressive episodes with psychotic features. So, according to that, this 2002 research indicates that it affects approximately four out of every 1,000 individuals.

Delusional Depression Symptoms

Some of the most common symptoms of delusional depression are the following:

1. Emotional Symptoms

The most common emotional symptoms are:

  • Persistent feelings of sadness and hopelessness

In delusional depression, people often face a tough time feeling very sad and hopeless. These strong emotions get mixed up with untrue beliefs, making things even harder. 

  • Loss of interest or pleasure in activities

In many cases, people often lose interest in or pleasure in activities because of their heavy feelings and distorted beliefs, which make it hard for them to find happiness and joy in things they once loved.

  • Guilt or worthlessness 

In delusional depression symptoms, individuals may feel an overwhelming sense of guilt or worthlessness because they believe false things about themselves. These untrue thoughts make them feel really bad about who they are as a person, which leads to self-blame and feeling not good enough.

  • Anxiety 

In many cases, individuals suffer from extreme anxiety because their false beliefs create a constant sense of worry and fear. These false thoughts make everything seem more threatening, contributing to the overall feeling of unease.

  • Irritability 

Individuals suffering from delusional depression symptoms often feel irritated because people around them don’t believe them or agree with their thoughts, which causes frustration.

2. Cognitive Symptoms

The most common cognitive symptoms of delusional depression are:

  • Lack of focus

In delusional depression symptoms, the lack of focus happens not just because of false beliefs but also due to overwhelming emotions like sadness and anxiety. These strong feelings can create a foggy lens, making it challenging to concentrate on tasks.

  • Poor decision-making

In many cases, individuals may struggle with making decisions. One may make poor decisions because intense emotions and false thoughts can confuse your judgment and your ability to make your choice confidently. 

  • Delusions 

In delusional depression symptoms, individuals firmly hold onto a misleading story in their minds that is not true and has no evidence. Such individuals can have delusions about many things, such as that they might feel that their spouse might be cheating on them, somebody is following them or wants to kill them, everybody around them really hates them, they are unredeemable, and many more.

  • Memory loss issues

Not only can wrong beliefs contribute to memory problems, but the symptoms of delusional depression, with their emotional weight, can also make it harder to remember things clearly. Such feelings create a mental fog, impacting your ability to retain your memory.

  • Negative thoughts

In delusional depression, negative thoughts are like unhappy ideas that persist. It’s like having a gloomy filter on your thoughts, affecting how you see yourself and the world around you.

3. Behavioral Symptoms

The common behavioral symptoms are of delusional depression are:

  • Withdrawal from Social Interactions

People suffering from delusional depression symptoms usually avoid being around others because they feel really bad about themselves or worry that others see them negatively. These mistaken beliefs make social situations more challenging, leading to a choice to stay away as a way of dealing with difficult emotions. 

In delusional depression, if someone feels really bad about themselves because of untrue thoughts, they might think about hurting themselves. The false beliefs cause strong emotional pain, generating these thoughts. This 2018 research also suggests that the suicide risk is high in this condition.

  • Changes in personal hygiene 

Many people find it hard to do regular things like take a shower, groom themselves, or dress properly when they are suffering from delusional depression symptoms because their thoughts tell them that these things are not worth the effort. These changes, like not keeping up with hygiene, show that they are going through a tough time.

  • Neglecting your responsibilities 

Many individuals neglect their daily responsibilities like work, home chores, and family duties because their distorted thoughts make the daily tasks seem very challenging.

  • Substance abuse

In delusional depression, some people may turn to substance abuse, like drinking alcohol, nicotine, cocaine, or drug consumption, as a way to cope with the intense emotional pain caused by these distorted thoughts. 

  • Psychomotor retardation

In some cases, psychomotor retardation may happen, making people slow down physically. In such cases, everything becomes harder to do, from moving around to completing everyday tasks.

4. Physical Symptoms

The common physical symptoms of delusional depression are the following:

  • Changes in appetite and weight

In delusional depression, changes in appetite and weight can occur, with some experiencing a significant increase or decrease in weight. Many people may develop unhealthy eating habits, such as eating a lot or not eating at all.

  • Sleep disturbances

In many cases, sleep disturbances can happen, making it challenging to have a regular sleep pattern. Negative thoughts and intense emotions may contribute to difficulties falling asleep or staying asleep

  • Fatigue or lack of energy 

People suffering from delusional depression symptoms may feel tired and exhausted all the time because their emotional baggage and false beliefs make it harder for them to stay active throughout the day. 

You may experience constant headaches and body aches because of the intense mental stress and emotional strain that your body is going through. When your mind is upset, your body feels it too, and gets affected.

  • Decreased sex drive 

In delusional depression, a decrease in sex drive can occur due to the emotional impact of distorted thoughts, making intimacy feel challenging. False beliefs about yourself can affect how you feel about being close to others.

  • Digestive Problems 

Your stomach might feel upset because of all the stress that you are going through. It can send signals to your digestive system, causing issues like stomach discomfort.

Distinction From Other Related Disorders 

Delusional depression is often confused with other mental disorders due to overlapping symptoms. So let’s discuss the key differences between delusional depression and some of the other related disorders:

1. Delusional Depression VS Psychotic Depression

Delusional depression is when someone feels really sad along with other symptoms of depression and has really strong beliefs that aren’t true. These beliefs are known as delusions.

Psychotic depression is a bit similar, but here, people might see or hear things that others don’t. These things, called hallucinations, aren’t real, but they feel real to the person experiencing them. It’s like an extra layer of not-so-real stuff happening along with the sadness.

The key difference is that in delusional depression, the focus is on strong false beliefs, while in psychotic depression, there is an added element of seeing or hearing things that aren’t there. 

2. Delusional Depression VS Schizoaffective Disorder

Schizoaffective disorder is a mental health condition that sticks around for a long time and mixes symptoms from two things: schizophrenia and mood disorders, or having mood swings (bipolar disorder in some cases). This disorder is a bit rare, which is why doctors often confuse it with schizophrenia or bipolar disorder.

The main difference between both is that schizoaffective disorder is a combo of both schizophrenia and mood disorders, while delusional depression focuses more on having fixed false beliefs with depressive symptoms.

3. Delusional Depression VS Delusional Disorder

Delusional disorder is mainly about having false beliefs without intense feelings of sadness or depression. The focus here is more on untrue thoughts.

So, in short, the main difference between both of them is that delusional depression mixes depression with false beliefs, while delusional disorder is more about having false beliefs without the extra weight of deep sadness.

4. Delusional Depression VS Schizophrenia

Schizophrenia is a mental health condition in which a person experiences hallucinations, delusions, disorganized thoughts, disorganized speech, trouble with thinking, and a lack of motivation.

The key difference between both is that schizophrenia deals with other major symptoms along with delusions, while delusional depression symptoms mainly involve false beliefs and intense sadness.

What Causes Delusional Depression?

Let us discuss the common causes of delusional depression symptoms: 

  1. Personality Traits

Certain personality traits, like a tendency to overthink or be overly self-critical, might contribute to the development of delusional depression.

  1. Cognitive Factors

Distorted thinking patterns, such as consistently interpreting situations in a negative light, may play a role in the onset of delusional depression symptoms.

  1. Biological Factors

Imbalances in specific areas of the brain and neurotransmitters (chemicals in the brain) can contribute to delusional depression, leading to a mix of deep sadness and distorted thoughts.

  1. Early Life Experiences 

Negative experiences in childhood, such as a lack of emotional support and love, can impact your mental health and potentially contribute to delusional depression symptoms later in life.

  1. Genetic Factors

If someone in your family has delusional depression or related conditions, there might be a genetic link, where certain traits are passed down from parents to children. 

  1. Environmental Factors

Stress plays a very significant role in triggering delusional depression symptoms. Other environmental factors involving alcohol and substance use may increase the risk. Social isolation, distrust, and suspicion are additional factors that may cause delusional depression symptoms.

  1.  Psychological factors 

Psychological states such as feelings of loneliness, jealousy, and low self-esteem can contribute to forming delusional thoughts, which further cause delusional depression symptoms. 

  1. Emotional Factors 

Your way of dealing with your emotions, like being overly sensitive or using specific defense mechanisms, might be the reason for your delusional depression symptoms.

  1. Life Changes and Trauma 

Life changes such as moving to a new place, facing financial challenges, losing your job, and many other challenging conditions can be triggering factors for your delusional depression. Traumas in life like a major accident, the loss of a loved one, abuse, and many more can be the major reasons for your condition.

Impact of Delusional Depression on Relationships

According to a 2023 research study, any form of depression with psychotic features can negatively impact romantic relationships and affect relationship satisfaction.

The following are some ways that delusional depression may affect your interpersonal relationships:

  • You may distance yourself from your close family or friends due to delusional depression symptoms
  • Your distorted thoughts can cause misunderstandings, as you might perceive every interaction in a way that doesn’t align with reality 
  • You might have difficulty in understanding others or expressing yourself due to your false beliefs  
  • A decrease in intimacy with your spouse due to your emotional state 
  • Your support system might get affected as your friends and family might find it hard to understand your situation.
  • The overall emotional distress can lead to an increase in tension in your relationships 
  • You might develop trust issues and question the intentions and sincerity of the people around you 
  • Your partner, family, and friends may deal with additional responsibilities while you navigate through your emotional challenges 
  • Your long-term goals and aspirations may be affected by uncertainty in delusional depression
  • Engaging in social activities might decrease, affecting shared experiences and the overall quality of relationships

Is Delusional Depression Treatable?

Yes, delusional depression is treatable through a combination of medication and psychotherapy.

The findings of this 1985 research also suggest that the combination of amitriptyline and perphenazine is a promising treatment option for patients with delusional depression. However, more research is needed to confirm these findings and to determine the optimal dosage and duration of treatment.

Treatment of Delusional Depression

Following are some of the most effective treatment options of delusional depression:

1. Cognitive-Behavioral Therapy (CBT)


Structured, goal-oriented therapy focusing on distorted thoughts and behaviors.


CBT helps individuals understand the connection between their thoughts, emotions, and actions. Therapists assist in identifying negative thought patterns contributing to depressive symptoms. 

2. Rational Emotive Behavior Therapy (REBT)


Focuses on identifying and challenging irrational beliefs contributing to distress.


REBT aims to pinpoint and confront irrational beliefs that fuel delusional depressive symptoms. It involves disputing and replacing these beliefs with more rational and constructive thoughts, thereby reducing emotional distress and improving coping mechanisms.

3. Family-Focused Therapy


It involves psychoeducation, communication improvement, and problem-solving skills.


This therapy extends beyond the individual to include family members. Psychoeducation provides information about delusional disorder, helping family members understand and support the affected individual. Communication improvement training aims to enhance family interactions and problem-solving skills training equips both the individual and their family with effective coping strategies.

4. Electroconvulsive Therapy (ECT)


It aims to use controlled seizures for relief from treatment-resistant psychotic depression symptoms.


ECT involves the controlled administration of electric currents to induce a brief seizure. While the exact mechanism is not fully understood, ECT has shown efficacy in severe cases of depression, including delusional depression. A medical team typically administers it under anesthesia and closely monitors the process.

5. Antidepressants


To reduce the symptoms of depression, including mood disturbances.


Antidepressants are medications that aim to balance neurotransmitters in the brain, such as serotonin. While they are not typically the first line of treatment for delusional depression, they may be prescribed in conjunction with antipsychotics or as an alternative, depending on the individual’s response. The two major types are:

Selective Serotonin Reuptake Inhibitors (SSRIs) 

Increase serotonin levels in the brain, promoting a more balanced mood. For example:

  • Fluoxetine 
  • Sertraline 
  • Paroxetine

Serotonin-Norepinephrine Reuptake Inhibitors ( SNRIs)

Increase both serotonin and norepinephrine levels, impacting mood regulation. For example:

  • Venlafaxine 
  • Duloxetine  

This 1981 research study suggests that delusional depression can be less responsive to traditional antidepressants and may benefit from additional therapies such as antipsychotics or ECT( Electroconvulsive) therapy.

Remember, it’s essential to consult a healthcare professional for proper diagnosis and treatment. Never self-medicate. Always use prescription medication as directed by your doctor. Abruptly stopping prescribed medication can have adverse effects on your health. Prioritize your well-being by seeking professional advice and following recommended guidelines.

Coping Strategies for Delusional Depression

Some of the helpful coping strategies for delusional depression are:

  • Understand delusional depression symptoms better for self-awareness or to help someone in your family
  • Engage in individual psychotherapy to address personal challenges or participate in family-focused therapy sessions if your family member needs it
  • Work on modifying negative thought patterns and behaviors for yourself or your family
  • Consistently take prescribed medications as directed or remind your loved one if they are suffering from this condition
  • Develop strategies to cope with challenges and support your loved one
  • Create a supportive and loving environment for your loved one
  •  Build a stable routine for yourself or help your family members set their own.
  • Be aware of your own warning signs or monitor your closed ones if required
  • Prioritize personal well-being and be a caregiver for your family if they are going through this condition 
  • Seek professional help yourself or encourage your family member to seek help if required 

This 2021 study suggests that family work and a strength-based approach can be beneficial in the recovery of individuals with any sort of psychotic symptoms.

Wrapping Up

In summary, we’ve addressed the importance of breaking the silence around mental health, emphasizing that delusional depression is a challenge and taking help is not only okay but a sign of strength. Throughout, we’ve explained what delusional depression is, its causes, symptoms, treatment approaches, and coping strategies. By building understanding and support, we can promote early intervention and nurture a compassionate community. Let’s continue working together to eliminate judgment and create a world where everyone feels heard and supported in their mental health journey. 

Frequently Asked Questions (FAQs) 

Here we have answered some of the most frequently asked questions about delusional depression.

1. What are Psychotic Features and Psychotic Depression?

Psychotic depression is a specific form of depression that includes experiences known as psychotic features. The common psychotic features are: 

  • Seeing or hearing things that are not present there ( Hallucinations)
  • Having strong beliefs that aren’t true ( Delusions)
  • Feeling slowed down physically ( Psychomotor impairment)
  • Feeling a bit lost or in a foggy state ( A Stupor)
  • Confused and disturbed thoughts and lack of concentration

Depressive psychosis is like having extra challenges on top of the usual depression symptoms. It is usually treated with antipsychotic medications and therapy. A 2013 study shows that a meta-analysis of 12 studies found that the combination of an antidepressant and an antipsychotic was significantly more effective than either antidepressant or antipsychotic monotherapy in the treatment of psychotic depression.  

2. What is Psychosis? 

Psychosis is a mental health condition characterized by a disconnection from reality, often involving hallucinations or delusions. It can impact thoughts, perceptions, and behaviors.

3. Can depression cause hallucinations?

Severe depression, particularly in the form of psychotic depression, can lead to hallucinations.

4. What are the types of hallucinations in depression? 

There are, mainly, two types:

  • Hearing sounds or voices that are not real
  • Seeing images, objects, or people that are not actually present

5. What is paranoid depression?

Paranoid depression is a subtype of major depressive disorder (MDD) where individuals suffer from deep sadness along with strong beliefs that others are trying to harm them or are against them.

6. How long can depressive psychosis last?

The duration can vary, but episodes can last for weeks to months, with the severity and treatment affecting the time frame.