Sometimes, you can have depressive symptoms in the early stages of schizophrenia before or while you experience psychosis, but these disorders are separate diagnoses. Major depression doesn’t become schizophrenia.
Schizophrenia and depression share similar symptoms, but they are different types of disorders. Schizophrenia is a psychotic disorder that affects your ability to tell what’s real, whereas major depression is a mood disorder that affects your emotional state.
You can have both conditions or one condition with some symptoms of the other. Sometimes, you can have depressive symptoms in the early stages of schizophrenia before or while you experience psychosis, but these disorders are separate diagnoses. Major depression doesn’t become schizophrenia.
What is major depression?
Also called clinical depression, major depression occurs when you feel persistently sad for weeks or months. It’s more than having sad feelings or feeling low once in a while. It’s a dark mood that can consume your life and cause you to lose interest in all routines and activities.
Symptoms of major depression are different for everyone. You might feel irritable and tearful or have no motivation to do anything. Some people have thoughts of suicide or self-harm. Depression can also cause physical symptoms like:
What is schizophrenia?
Schizophrenia is a serious mental illness that causes extremely muddled thinking and problems knowing what is real, which is called psychosis. It causes hallucinations (i.e., seeing or hearing things that others don’t) and delusions (i.e., having a firm belief about something that is untrue or doesn’t exist).
People with schizophrenia also withdraw from the world and lose interest in daily activities and people. Over time, you become more withdrawn and have trouble with self-care and personal hygiene, and you don’t bother with your appearance.
Symptoms of schizophrenia include:
- Hearing voices
- Seeing lights or shadows that aren’t there
- Bizarre beliefs in things like your own ability to raise people from the dead
- Jumbled speech
- Hazy thoughts
- Lack of emotion
It’s common to have symptoms of depression and anxiety, too. Reports show that 61% of people with an acute episode of schizophrenia also experience depression.
Does depression cause psychosis?
Major depression can cause psychosis and delusional thinking. This is called psychotic depression or major depressive disorder with psychotic features. It usually reflects the person’s deeply depressed mood.
For example, if you have major depression, you might have a feeling of deep guilt and become convinced you’ve done something wrong or committed a crime. Alternatively, you might have paranoia or a suspicious belief that something bad is about to happen. You might even hear voices.
These things feel very real while you’re experiencing them, and it’s hard to tell that these are symptoms of depression. While you can have hallucinations and delusions during a period of psychotic depression, it’s not the same thing as schizophrenia and doesn’t lead to schizophrenia. Studies show that brain activity is different in those who have schizophrenia.
Studies also show that having a family history of schizophrenia doesn’t give you a higher risk of having psychotic depression, so having one disorder or the risk of one disorder doesn’t necessarily mean that you’ll be at greater risk of having the other.
How can you tell the difference between schizophrenia and depression?
Schizophrenia and depression are hard to tell apart, which makes diagnosis complicated. There is even debate among experts about how to classify these disorders. Some feel depressive symptoms should be a symptom of schizophrenia, and others feel it should be considered a co-existing condition.
The official diagnostic manual (called the DSM-5) recognizes that depression can be part of schizophrenia, but it lists them as separate conditions.
The key difference between the disorders, and especially between psychotic depression and schizophrenia, is that psychosis in depression is sporadic and only occurs during a period of depression. In cases of schizophrenia, you experience psychotic symptoms even when you don’t have a mood problem.
Schizophrenia also causes more problems with self-care and lack of personal hygiene.
Additionally, there are also differences in emotions between schizophrenia and depression. Where you might be sad and tearful during an episode of major depression, schizophrenia often causes a lack of emotion. This is called emotional flattening.
- Speak in a monotone voice
- Avoid eye contact with others
- Not change your facial expressions
- Have a total lack of response to things around you
Schizophrenia also causes extremely disorganized behavior, thinking, and speech. When you talk, you might put random words together that make no sense, which is called word salad. You might sit in bizarre postures or not move at all, resist instructions, or become agitated or childlike.
The best way to know what condition you have is to talk to your psychiatrist. They are an expert in diagnosing and treating mental illnesses.
How are schizophrenia and depression treated?
The main treatments for schizophrenia are medication and therapy. Your doctor will prescribe an antipsychotic medication that blocks a brain chemical called dopamine. This will help control symptoms of psychosis. You’ll need to take them even after symptoms pass and you get better.
There are two types of antipsychotic medications: first-generation, which were created in the 1950s, and second-generation, which were created in the 1990s. Your doctor will probably prescribe second-generation medications because they have a lower risk of side effects.
Some of these medications can include:
If you have a mild form of major depression, your doctor might first suggest therapy and a wait-and-see approach. If it gets worse and nothing helps, they might treat it with medication or combine medication and therapy.
Antidepressants include medications like:
If you have psychotic depression, your doctor might also prescribe antipsychotic medication. Therapy for both conditions can involve talking, art, or family therapy.
Both schizophrenia and major depression are serious mental illnesses that affect your life. Depression is often a part of schizophrenia and other mental illnesses, but they are still separate conditions. Major depression doesn’t turn into schizophrenia.
Treatment can help you manage either condition.
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Medically Reviewed on 4/11/2022
Frontiers in Psychiatry: “Schizophrenia and Depression Co-morbidity: What We Have Learned From Animal Models.”
Harvard Medical School Harvard Health Publishing: “Six common depression types.”
Mayo Clinic: “Clinical depression: What does that mean?” “Depression (major depressive disorder),” “Schizophrenia.”
Mind: “Types of psychosis,” “What are symptoms of schizoaffective disorder.”
National Health Service: “Overview — Schizophrenia,” “Psychotic depression,” “Symptoms — Clinical depression,” “Symptoms — Schizophrenia.” “Treatment — Clinical depression,” “Treatment — Schizophrenia.”
Schizophrenia Bulletin: “Challenges in the Treatment of Major Depressive Disorder With Psychotic Features.”