Psychotic Depression occurs when a severe depressive illness is accompanied by some form of psychosis, such as a break with reality, hallucinations, or delusions. Psychotic symptoms typically develop after an individual has already experienced several episodes of depression without psychosis. However, once psychotic symptoms emerge, they tend to reappear with each subsequent depressive episode.

Individuals who have experienced a depressive episode with psychotic features are at an increased risk of relapse and suicide compared to those without psychotic features. They also tend to have more pronounced sleep abnormalities.