Perhaps the most surprising aspect many an elderly individual and also their caregivers experience when faced with depression is the fact that psychotic depression is indeed part of the elderly depression spectrum. Although extremely rare in diagnosis, in retrospect many an elderly individuals suicide is linked back to an episode worthy of being classified as severe psychosis.
In the most general of terms, psychotic depression refers to the form of depression that is so severe that it may produce actual auditory or visual hallucinations in the affected senior. She or he may believe to hear the voice of a loved one who has passed on, or in some cases believes to overhear a plot to poison or otherwise do away with her or him.
Paranoia and delusions do frequently appear concurrently and yet diagnosis is made more difficult if other ailments are present, especially if there is a suspicion of Alzheimers disease.
Although there is precious little proof, there has been the suggestion made that those individuals suffering from elderly psychotic depression will actually present with major depression first and the decline into psychotic depression may be so gradual that caregivers and even physicians may initially miss the onset of the new condition. As the paranoia accompanies the condition, there are times when the senior will not volunteer any change in depression or say or do anything that might put them in jeopardy of any imagined outcome.
Suicide is sometimes the end result of a psychotic episode and although there is very little, if anything that a conscientious doctor or caregiver could have done to avoid it, much soul searching and years of pain do lie ahead for the survivors connected to the affected senior. Some have suggested that the manic state of bipolar disorder holds the same risk, although by and large it has been found that unless there is an extreme case of mania, the effects of psychotic depression are hard to replicate in others forms of the illness.
Paranoia and Hallucination
In a most interesting twist, even as psychotic depression is known to bring on hallucinations, the sufferer is acutely aware in some cases that the hallucinations are not real, yet in the case of paranoia is unable to make that some connection.
Thus you will find that within the spectrum of elderly depression the feelings of hopelessness are pronounced while this also may give rise to aggression both physical and verbal.
Seeking out help in such a case is an elderly persons only hope at healing and getting well, yet sadly they are unable to either see the need or fulfill it, and thus it is up to a caregiver or loved one to make that phone call in search of help. Add to this the fact that a patient may be hesitant to admit to suicidal thoughts, paranoia, or even hallucinations for fear of being “put away", and the recipe for disaster is complete.
Treatment commonly does require hospitalization and close monitoring to ensure that the patient will not give in to suicidal thoughts or temptations. On the upside, the odds of getting well are good.