The symptoms of psychotic depression are a combination of symptoms of depression and psychosis. This condition occurs when a depressed person loses touch with reality and hallucinates or experiences delusions.

The content of these delusions and hallucinations can be consistent with depression. For example, some people hear voices criticizing them, telling them that they are inadequate or evil, or telling them that they don't deserve to live and should kill themselves. Psychotic depression requires immediate medical attention to prevent self-harm or harm to others.

A clinical evaluation consisting of a psychiatric evaluation, a physical examination, and laboratory tests are used to make the diagnosis. Other medical conditions that can cause the same symptoms (such as reactions to certain drugs) should be ruled out.