Sanil Rege covers the symptoms of severe depression with a focus on melancholic and psychotic features in depressive disorder.
Melancholic and psychotic depressions are both severe forms of depression associated with a high degree of morbidity and suicide risk.
Features of Severe melancholic and psychotic depression:
psychomotor disturbance
impaired cognitive functioning (frontalsubcortical circuits)
slowing of mental and motor activity
Physical symptoms, e.g. constipation, menstrual irregularities, lowered BP
Ruminations – themes of hopelessness, pessimism, selfaccusation, selfderogation, feelings of inadequacy and of being a failure
Periods of agitation
More significant biological and genetic determinants than psychosocial
Shows a minimal response to placebo
Show a superior response to biological treatments such as broadspectrum antidepressant medication and electroconvulsive therapy rather than to psychotherapy.
Psychotic depression presents with delusions: nihilistic, obsessional guilt, poverty and hypochondriacal are common themes

⛑ Patients with psychotic depression have double the risk of dying than nonpsychotic depression and higher odds of completed suicide. [Vythilingam M et al., 2003]., [Gournellis R et al., 2018]
Psychotic depression is best conceptualised as melancholic depression with psychotic features (e.g. delusions, hallucinations, guilty ruminations).

Treatment requires broadspectrum antidepressants in melancholic depression and augmentation strategies as second and thirdline treatments.

Psychotic depression requires antidepressants and antipsychotics as initiating treatments
Read more on melancholic and psychotic depression: https://psychscenehub.com/psychinsigh...