This is your brain on Psychotic Major Depression
Something I wrote on my Facebook page in response to a question someone had, I thought I'd share it here as well for educational purposes. 
Before we begin, let me just say that everyone sees or hears things that aren't really there from time to time. Seeing shadows out the corner of your eye, an object in a room suddenly appearing different for a moment, your surroundings not seeming quite real, hearing your name being called, and so on, all of these things are a perfectly normal response to stuff like stress, anxiety, and lack of proper sleep, and do not automatically indicate that you have, or are developing a psychotic type illness.
So what is 'Psychotic Major Depression', also known as Major Depressive Disorder with Psychotic Features, and what is it like to actually experience an episode? (N.B I will be talking only about my own direct experiences, but please be aware the experience of Psychotic Depression can be different for everyone, and can also vary in severity.)
Psychotic depression is characterized by not only depressive symptoms, but also by hallucinations (seeing or hearing things that aren't really there) or delusions (irrational thoughts and fears). While people with other mental illness, like schizophrenia also experience these symptoms, those with psychotic depression are usually aware that these thoughts aren't true.
http://www.healthyplace.com/depression/main/psychotic-depression/menu-id-68/
It's hard to explain what it's really like to experience an episode of Psychosis in relation to Depression; I believe the character of Louis in Interview with the Vampire probably said it best (paraphrased) - 'Everything around you has changed, and yet remains the same'. There is a sense of isolation, of feeling as if you're experiencing the world through a transparent barrier, but at the same time you suddenly feel hyper connected and switched into everything around you. Little things begin to take on significance, colours seem brighter, sounds are louder, your mind begins to try and convince you of higher levels of awareness - you can become fixated on words, street signs, the arrangement of leaves on a tree, believing that if you can just decipher the pattern some great spiritual truth will be revealed, or you will receive a sign that will avert some major disaster. This 'receiving messages' can extend into a sense that you are personally responsible for the lives of countless strangers - natural disasters, wide spread tragedies, everything suddenly becomes 'your fault'. You're the one who didn't pay attention to the signs, you're the one that missed some vital clue that could have averted these horrible events, people are dead because of you. Again there is that sense of being beyond connected and yet operating completely alone, with the weight of the world on your shoulders.
Paranoia is also common in my experience with Psychotic Depression. Your mind races with delusional ideas of hidden cameras, secret tracking devices, your thoughts being recorded and broadcast to the world; people are laughing at you, not with you. You know these thoughts have no basis in reality, and yet your mind is still hammering at you 'what if, what if...What if it is true, how can you be sure? Pay attention, watch out!'. I've had delusional thoughts and hallucinations that the street lights near our house were really loud speakers set up to broadcast my thoughts to the world, times where my mind has tried to convince me that Black Hawk Helicopters were amassing for a military strike against me, I was being monitored through implant devices in my computer, the security cameras on buses were set up to specifically film me so that my image could be mocked and laughed at.
Paranoia can also extend to concerns about your own health that are out of proportion to any actual evidence, and usually take the form of feeling as if you are being punished for some perceived wrong. There have been times I have felt my body rotting away from the inside, believing I was infected with AIDS, Cancer - all manner of potentially horrid illnesses - my mind trying to convince me that this was really happening, the illnesses were real, and being visited on me, because I deserved to be punished. For what I’ve never known, the psychosis seems very convincing at times, but it can be a little lacking in the detail.
Hallucination wise I experience both auditory and visual hallucinations. I also experience illusions like I described at the beginning. The difference between illusions and hallucinations, in my experience, is profound. An illusion is more like a fleeting image, a hallucination can look so real that you'll reach out to touch it in the split second before you realise what it is. With Psychotic Depression in particular, often the hallucinations can be very dark in nature, centred around things like evil, and death. It might sound strange, but in a way these are easier to deal with, despite their disturbing nature, than hallucinations that seem to have more of a basis in reality. It's easier to see a demon, and know that it's not real. It's a bit harder to see a fully formed, regular looking person, and be able to recognise the same thing.
Auditory wise I hear different types of music, usually emanating from objects, an orchestra coming from the fridge, the kettle playing anything from rock-a-billy to bluegrass & jazz, for example. I also hear a child's choir singing what sounds like a funeral dirge in Latin, children laughing, a cacophony of voices talking all at once (like being in a crowd), white noise, occasionally the sounds of people moaning in terror or pain. Sometimes the TV talks to me as well, I'll hear presenters on different shows calling me an idiot, or telling me I'm bad, although I've never been quite sure whether to categorise that as an auditory, or visual hallucination. Strictly speaking I suppose it's both.
Visual wise I've seen demons, screeching black winged creatures, severed body parts lying on the ground, squashed dead animals, deformed ghostlike figures scratching at the windows, distorted faces, & black clad Ninja type figures breaking through the walls, & descending from the ceiling, bugs and spiders crawling over things, a hag like old woman sitting on the end of my bed. As I mentioned before I also see stuff that is based more in reality, people that aren't really there, a man riding a bicycle who suddenly disappears, for example, cats and kittens that look so real I've reached out to pet them. Very occasionally I'll also see things that are really quite beautiful, or amusing in some way, the stars in the sky turning into Chinese paper lanterns, or the trees and plants in our front yard dancing in time to a techno beat. In a way I've come to cherish these hallucinations, because they provide a welcome respite from the more typical 'doom and gloom' ones that are more of a hallmark of psychotic depression for me. I mean after all, who wouldn't prefer to see pretty lanterns hanging in the sky, funny dancing plants, or cute fluffy cats and kittens, as opposed to demons and dead things.
Of course to be diagnosed with Psychotic Major Depression you have to have the Depression component as well. None of my psychotic symptoms have ever occurred outside of a depressive episode. If they had, I'd be looking at a different diagnosis. The severity of the depression, in my experience, can vary from a milder, 'I didn't even really know I was depressed until I looked back and noticed a few symptoms in hindsight' type experience, to a more severe 'I'm struggling to get out of bed, everything is just too much effort, and I stink because I haven't showered or changed my clothes in a week' type depressive episode. The one thing I have noticed that seems to be consistent with Psychotic Depression, in my experience at least, is that regardless of the severity of the depression it tends to be centred a lot more around physical symptoms (headaches, stomach upsets, changes in appetite, sleep disturbances, and so on), and is also more along the lines of what is sometimes known as 'agitated' depression, where anxiety and feelings of panic, along with a general sense of emptiness, and apathy, are more at the forefront, rather than the more classic, 'I'm so sad, I'm crying all the time, and I don't know why' type presentation.
Anyway, that's Psychotic Major Depression, as best I can explain it from my own personal experience at least. If you, or anyone you know recognises any of the symptoms described, please do not try and diagnose yourself. Make an appointment with a Psychiatrist, and have a proper assessment done, including a full physical exam to rule out any possible physical causes for what you might be experiencing.
Before we begin, let me just say that everyone sees or hears things that aren't really there from time to time. Seeing shadows out the corner of your eye, an object in a room suddenly appearing different for a moment, your surroundings not seeming quite real, hearing your name being called, and so on, all of these things are a perfectly normal response to stuff like stress, anxiety, and lack of proper sleep, and do not automatically indicate that you have, or are developing a psychotic type illness.
So what is 'Psychotic Major Depression', also known as Major Depressive Disorder with Psychotic Features, and what is it like to actually experience an episode? (N.B I will be talking only about my own direct experiences, but please be aware the experience of Psychotic Depression can be different for everyone, and can also vary in severity.)
Psychotic depression is characterized by not only depressive symptoms, but also by hallucinations (seeing or hearing things that aren't really there) or delusions (irrational thoughts and fears). While people with other mental illness, like schizophrenia also experience these symptoms, those with psychotic depression are usually aware that these thoughts aren't true.
http://www.healthyplace.com/depression/main/psychotic-depression/menu-id-68/
It's hard to explain what it's really like to experience an episode of Psychosis in relation to Depression; I believe the character of Louis in Interview with the Vampire probably said it best (paraphrased) - 'Everything around you has changed, and yet remains the same'. There is a sense of isolation, of feeling as if you're experiencing the world through a transparent barrier, but at the same time you suddenly feel hyper connected and switched into everything around you. Little things begin to take on significance, colours seem brighter, sounds are louder, your mind begins to try and convince you of higher levels of awareness - you can become fixated on words, street signs, the arrangement of leaves on a tree, believing that if you can just decipher the pattern some great spiritual truth will be revealed, or you will receive a sign that will avert some major disaster. This 'receiving messages' can extend into a sense that you are personally responsible for the lives of countless strangers - natural disasters, wide spread tragedies, everything suddenly becomes 'your fault'. You're the one who didn't pay attention to the signs, you're the one that missed some vital clue that could have averted these horrible events, people are dead because of you. Again there is that sense of being beyond connected and yet operating completely alone, with the weight of the world on your shoulders.
Paranoia is also common in my experience with Psychotic Depression. Your mind races with delusional ideas of hidden cameras, secret tracking devices, your thoughts being recorded and broadcast to the world; people are laughing at you, not with you. You know these thoughts have no basis in reality, and yet your mind is still hammering at you 'what if, what if...What if it is true, how can you be sure? Pay attention, watch out!'. I've had delusional thoughts and hallucinations that the street lights near our house were really loud speakers set up to broadcast my thoughts to the world, times where my mind has tried to convince me that Black Hawk Helicopters were amassing for a military strike against me, I was being monitored through implant devices in my computer, the security cameras on buses were set up to specifically film me so that my image could be mocked and laughed at.
Paranoia can also extend to concerns about your own health that are out of proportion to any actual evidence, and usually take the form of feeling as if you are being punished for some perceived wrong. There have been times I have felt my body rotting away from the inside, believing I was infected with AIDS, Cancer - all manner of potentially horrid illnesses - my mind trying to convince me that this was really happening, the illnesses were real, and being visited on me, because I deserved to be punished. For what I’ve never known, the psychosis seems very convincing at times, but it can be a little lacking in the detail.
Hallucination wise I experience both auditory and visual hallucinations. I also experience illusions like I described at the beginning. The difference between illusions and hallucinations, in my experience, is profound. An illusion is more like a fleeting image, a hallucination can look so real that you'll reach out to touch it in the split second before you realise what it is. With Psychotic Depression in particular, often the hallucinations can be very dark in nature, centred around things like evil, and death. It might sound strange, but in a way these are easier to deal with, despite their disturbing nature, than hallucinations that seem to have more of a basis in reality. It's easier to see a demon, and know that it's not real. It's a bit harder to see a fully formed, regular looking person, and be able to recognise the same thing.
Auditory wise I hear different types of music, usually emanating from objects, an orchestra coming from the fridge, the kettle playing anything from rock-a-billy to bluegrass & jazz, for example. I also hear a child's choir singing what sounds like a funeral dirge in Latin, children laughing, a cacophony of voices talking all at once (like being in a crowd), white noise, occasionally the sounds of people moaning in terror or pain. Sometimes the TV talks to me as well, I'll hear presenters on different shows calling me an idiot, or telling me I'm bad, although I've never been quite sure whether to categorise that as an auditory, or visual hallucination. Strictly speaking I suppose it's both.
Visual wise I've seen demons, screeching black winged creatures, severed body parts lying on the ground, squashed dead animals, deformed ghostlike figures scratching at the windows, distorted faces, & black clad Ninja type figures breaking through the walls, & descending from the ceiling, bugs and spiders crawling over things, a hag like old woman sitting on the end of my bed. As I mentioned before I also see stuff that is based more in reality, people that aren't really there, a man riding a bicycle who suddenly disappears, for example, cats and kittens that look so real I've reached out to pet them. Very occasionally I'll also see things that are really quite beautiful, or amusing in some way, the stars in the sky turning into Chinese paper lanterns, or the trees and plants in our front yard dancing in time to a techno beat. In a way I've come to cherish these hallucinations, because they provide a welcome respite from the more typical 'doom and gloom' ones that are more of a hallmark of psychotic depression for me. I mean after all, who wouldn't prefer to see pretty lanterns hanging in the sky, funny dancing plants, or cute fluffy cats and kittens, as opposed to demons and dead things.
Of course to be diagnosed with Psychotic Major Depression you have to have the Depression component as well. None of my psychotic symptoms have ever occurred outside of a depressive episode. If they had, I'd be looking at a different diagnosis. The severity of the depression, in my experience, can vary from a milder, 'I didn't even really know I was depressed until I looked back and noticed a few symptoms in hindsight' type experience, to a more severe 'I'm struggling to get out of bed, everything is just too much effort, and I stink because I haven't showered or changed my clothes in a week' type depressive episode. The one thing I have noticed that seems to be consistent with Psychotic Depression, in my experience at least, is that regardless of the severity of the depression it tends to be centred a lot more around physical symptoms (headaches, stomach upsets, changes in appetite, sleep disturbances, and so on), and is also more along the lines of what is sometimes known as 'agitated' depression, where anxiety and feelings of panic, along with a general sense of emptiness, and apathy, are more at the forefront, rather than the more classic, 'I'm so sad, I'm crying all the time, and I don't know why' type presentation.
Anyway, that's Psychotic Major Depression, as best I can explain it from my own personal experience at least. If you, or anyone you know recognises any of the symptoms described, please do not try and diagnose yourself. Make an appointment with a Psychiatrist, and have a proper assessment done, including a full physical exam to rule out any possible physical causes for what you might be experiencing.