Can you describe the difference between negative symptoms and depression?

i have had two periods of time when negative symptoms plagued me, observed as such by professionals. one was when i was in long term care (2008-2009) after a really, really bad break that had me out of my head for several weeks and my memory is spotty, but fifteen months later i was living at home. the second one was after i had bilateral ECT (2012) for command hallucinations that were getting increasingly problematic and i had slipped in and out of catatonia and clozaril failed. each was probably about a year long. i feel like it’s happening again. just, zero affect and even more detached than usual. crushing blah.

i’ve never been diagnosed with a mood disturbance, but i have had “post psychosis depression” and after speaking with a friend yesterday i now wonder if really i don’t have some type of depression. maybe i don’t have schizophrenia at all and just have psychotic depression. i mean, probably not, but this depression thing versus negative symptoms, does anyone who’s had both, can you describe the difference?

This is a big issue for me as well. I suffer from bipolar (mood symptoms including depression) I dont know how to differentiate depression with negative symptoms of SZ - I do have SZ traits or some flavoring of SZ
I do think that you should let your doctor know whats going on with you - let him know about your depressive episodes.
True Negative symptoms of SZ are difficult to treat - if you have negative symptoms from depression, it is easier to treat - antidepressants maybe. I take an antidepressant type mood stabilizer but still suffer from lack of motivation - maybe my depression still exists chronically at a low level and I still am suffering from lack of motivation?
It could also be the meds in my case - but it is very difficult to pinpoint where my lack of motivation exactly comes from -it could be a combination of reasons

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cheers for your reply. that makes sense. part of my going onto clozaril was to treat them. it didn’t work. but then i had other stuff going on, too.

my care team has expressed reluctance to give me anything with antidepressant properties in the past because they fear it’ll make the psychosis worse. i’ve not been diagnosed with bipolar or depression in the past, but i don’t know if they’ve ever looked into it. maybe?

the schizophrenia diagnosis has been since nineteen, but the negative symptoms (beyond asociality and either flat or inappropriate affect) didn’t present until more like early thirties. that’s why i’m suspicious. but then i fear if i say something they’ll just see it as another attempt to not face my diagnosis or whatever. ugh.



General practitioners have a key role in initial assessment and subsequent monitoring of depressive symptoms in patients with schizophrenia. Although depressive symptoms and negative symptoms of schizophrenia may appear similar, some features can help in differentiating them (Box). Primary negative symptoms of schizophrenia include apathetic withdrawal, restriction of affect and paucity of thought. Negative symptoms that are secondary to depressive symptoms may present in a similar fashion.

People with both schizophrenia and depression may have difficulty communicating a depressed mood or inner feeling state, thus limiting the clinical utility of direct questioning about their mood. Rather, questions about their interest in things and activities may be more useful in differentiating depressive symptoms. For example, a loss of interest in usual activities (anhedonia) is common in depression. In contrast, patients with negative symptoms of schizophrenia alone (“deficit” syndrome) may describe their interests in a bland and affectively restricted manner.

Eliciting feelings of guilt or hopelessness and suicidal themes and ideation may also assist in differentiation, and in evaluating risk of self-harm or suicide. Other features of depression include significant neurovegetative symptoms, such as poor sleep and appetite change, but in schizophrenia, circadian rhythms and appetite may be affected by the core disorder and some antipsychotic medications.

Risk assessment is crucial for anyone with schizophrenia and depressive symptoms, as suicide is a leading cause of death among people with schizophrenia. Other risks such as self-neglect and poor oral intake must also be assessed, as many people with schizophrenia are socially isolated and do not have carers providing support or monitoring their wellbeing.


i’m unsure i follow that well enough at the moment to digest it or what it means regarding which is happening with me right or how to differentiate. my concentration is crap right now. i’ll have to try to read later. but i appreciate the effort.

maybe here’s another question that occurs to me that might be the case:

can you have both? both negative symptoms underlying (the social withdrawal is and always has been something of a problem–chronic, definitely, as has the flatter than normal affect) and depression in a more episodic fashion?

i’m not just trying to question my diagnosis. i think maybe there’s something different or new or something wrong of late, but everything resembling these concerns has always just been chalked up to negative symptoms and i’m unconvinced that’s the whole picture. but maybe it is. i really don’t know.

To answer this - Yes you can have both, negative syptoms of SZ and depression - I may have both, but again if you have both it complicates the issue even more - Lets not forget the sedating antipsychotics, they too can play a role
I would have this discussion with your doctor - I know that I will be discussing my issue of lack of motivation - and see what she thinks

fair enough on the antipsychotics’ sedation. i do take zyprexa along with haldol injections. but i’ve taken those for a while. the zyprexa especially. for years. the depot got switched from prolixin earlier this calendar year, but typicals don’t tend to sedate me much. i think i adjust quickly overall.

i also take a fair amount of ativan to ward off catatonia. which is odd that that does that, but knock wood, so good so far. but, again, i’ve been taking for quite awhile. hmmm…

crap. maybe this was in vain to think it could be depression instead or have been all along. i looked at other threads and found this one:

what @SurprisedJ described as the difference, i’m definitely the non feeling apathetic flat one and not the feeling one. all of my feelings are on more an intellectual level. like i think i should feel or would if i had feelings feel xyz.

i can’t even say i have low energy, though i do feel slower in some respect, so much as lacking in motivation. but i truly thought those could be depression, too. maybe in part because negative symptoms are so unresponsive, not that depression can’t be treatment resistent, but i want something that could be alleviated or has a better chance at being. i’m just tired of everything chronically deteriorating.

I in my opinion think the difference between negative symptoms and depression is the following (I read it in a book about sz): In negative symptoms one feels emptiness and deadness, lack of emotion, and in depression one feels strong emotions such as sadness and grief and guilt and so on.

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for me negative symptoms from schizophrenia are like low energy, staying in bed all, not showering but BECAUSE of the hallucinations/paranoia telling you not to, the fear keeping you from doing it, etc.

then the depression which is different i think comes from feeling too sad to get up, actually wanting to get up but having no energy too, not taking a shower because whats the point, or you dont have the energy.

during my psychosis i could still take a shower just fine the voices in my head incouraged it. however, after i got on meds is when my energy was zapped and i couldnt leave the room because i was hyper sedated and meds caused me anxiety.

some peoples schizophrenia tells them to be afraid of the shower. to me thats negative symptoms

@etre I’m sorry your hitting a patch of that flat, rust brown emptiness.

I have to admit, I think my seroquel being cut back and the latuda added (which has some mood stabilizing properties) and getting of the heavy zoloft did help me start to emerge from my wax build-up.

At least with depression I still felt something and had a chance to feel a little bit of a waiver in the mood. But for me when the negative symptoms came… no wavering. Just a little more unable to reach out every day. Until I was so covered in wax I didn’t care about any thing. I hope you manage to beat this before it gets worse.

@Hadeda @cactustomato @SurprisedJ

thank you for sharing your understanding, experiences, and well wishes.

much to consider and much appreciated.

i’m going to talk to my psychiatrist some more at my thursday appointment.

theres a chart in my abnormal psych textbook, I will look at it when I have time later tonight and tell you what it says. It’s been a while since I looked at that chart so I dont remember the fine points, but they differences are clinical, they two disorders look very similar without professional training and I still stumped the doctors for a while.

thank you! i look forward to seeing what you find.

Might take me up to 24 hours, I just got assigned a paper due thursday and I have a test tomorrow. I will try to find time tonight, right now I need to work on the paper, then for a solid hour tonight I need to study as well, after a night class. Sigh. Supposedly college is worth it!


Ok so here it is- schizophrenics have avolition, difficulty engaging in desired behaviors while depressed people have anhedonia, lack of pleasure, both result in the patient displaying little of no interest in things, staring into space, ect.

depressed people have a lack of energy, while schizophrenics have difficulty organizing thoughts to speak, both resulting in short, empty replies to questions

depressed people feel undeserving of companionship while schizophrenics are overwhelmed by social situations and have difficulty socializing due to poor social skills, both resulting in social isolation.

  • taken from my abnormal psych textbook, a chart with behavioral symptoms and causes in depression and schizophrenia. Hope this helps, this is the text for psychologists, so it is basically as legit as possible.

Whenever I talk to someone I go rigid, and I start talking in a monotone. Then people start yawning. I guess that is what you would call the flat affect of sz. I’m glad you’re comparing the negative symptoms of sz to depression. They are very similar. I think the difference would be one of mood. Though they behave similar to depressives, sz’s don’t feel so hopeless. They might be able to look at their symptoms philosophically. Depression is a devastating mood disorder. Negative symptoms are a pattern of behavior. Sz’s might be troubled about their negative symptoms, but their mood is not so bad.

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Not schizophrenic but highlighted the parts that apply to me.

schizophrenics have avolition, difficulty engaging in desired behaviors while depressed people have anhedonia, lack of pleasure, both result in the patient displaying little of no interest in things, staring into space, ect.

depressed people have a lack of energy, while schizophrenics have difficulty organizing thoughts to speak, both resulting in short, empty replies to questions

depressed people feel undeserving of companionship while schizophrenics are overwhelmed by social situations and have difficulty socializing due to poor social skills, both resulting in social isolation.

With the second bit re lack of energy v difficulty organising, I didn’t highlight as the latter occurs on an on and off basis. Sometimes it’s easier to think up responses than others…

With the last bit I’m more scared of embarrassing myself (social anxiety) than thinking myself undeserving but the bit about difficulty socialising(I’m reckoned to have very poor social skills) very much applies.

With the first bit I experience a degree of pleasure but positive emotions are muted compared to negative ones. Lack of drive,difficulty thinking of goals, and low motivation which equals avolition is a chronic problem


cheers. it sounds like my diagnosis is already accurate as in line with what most of you describe for negative symptoms. i don’t know why i keep thinking there’s another answer year after year, but it is what it is. might see about doubling up the sarcosine or something. my overall give a crap is waning by the day though so we shall see. cheers for the input. the personal experiences are quite helpful to read as well as the definitions.