This condition occurs when a depressed person loses touch with reality and hallucinates or has delusions. People with psychotic depression have the combined symptoms of depression and psychosis.

The content of the delusions and hallucinations can be consistent with depression. For example, some people hear voices criticizing them, telling them that they are not good enough or evil, or telling them that they don't deserve to live and should kill themselves. People may develop feelings that their body is filled with cancer, or is ‘rotting inside.' Psychotic depression requires immediate medical attention to prevent self-harm or harm to others.

Diagnosis involves:

• Psychiatric evaluation
• Physical examination
• Laboratory tests

The health care provider should rule out other medical conditions that can cause the same symptoms (such as reactions to certain drugs).