What is the difference between me and you?

Between psychotic depression and schizophrenia? Doesn’t depression (or at least many symptoms of depression) count as negative symptoms? In which case I have both positive and negative symptoms, required for a diagnosis of schizophrenia. Reading a paper that talked about distinguishing the two mentioned that depression with psychotic features has the individual displaying psychotic symptoms only while in a depressive episode, but this is not the case for me. I experience positive symptoms all the time, depressed or not. In fact I have noticed that more commonly when I am depressed I have LESS positive symptoms. It is only rarely that I have experienced both a depressive and psychotic episode at the same time, and those were really, really awful.

My pdoc tells me she thinks I’m not schizophrenic because I have a higher degree of lucidity during my episodes. I am aware when I am experiencing something that other people would think is strange and I hide that I am experiencing those things, whereas a schizophrenic in a psychotic episode would have no awareness, would not hide it and would be hospitalized. It is common of psychotic depression to have this higher degree of lucidity, leading it to often get misdiagnosed or undiagnosed as people hide their positive symptoms.

Anyways I guess there’s just a fine line between the two. Anyone else have any thoughts or also have depression w psychotic features?


Back in 1987 I started out with a diagnosis of major depression with psychotic features. They treated me with Trilafon and tri-cyclic antidepressants. Then they changed my dx to sz and put me on a major tranquilizer.

I have depression with psychotic features. I was thinking of starting a thread on it because there seem to be plenty of questions about it.

It’s very closely related to sz/sza, the pattern of deficits and irregularities follows typical sz/sza presentation closely. People with psychotic depression to tend to have higher functioning on average, and more lucidity.

Delusions and hallucinations tend to be mood-congruent and have personally negative connotations - both may have paranoid persecutory delusions, for example, but while someone with straight up paranoid sz might think they are being monitored because someone is trying to steal their ideas, someone with psychotic depression will think it’s because they are wicked, disliked, criminal, etc.

Lucidity is a major distinguisher of paychotic depression. There is a very clear understanding that your thoughts are strange and incorrect, but what you know has little emotional relevance.

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When I had my major episodes I was sneaky about it to a degree. The voices told me I couldn’t tell anyone. But there’s really no hiding full blown psychosis. The first time my parents were minutes from dragging me to the mental hospital but I somehow figured out something was not quite right.

I believe it’s a continuum. What you call someone is a matter of degree.

It’s question of which ‘knobs’ are turned up on you and for how long that seems to bring one diagnosis or another.

Stay in a depressive state most of the time, and they say you are unipolar. Mix in some psychosis, then psychotic depression… Oops too much you’re SZ, not enough and turn up the mania knob and you have bipolar disorder too little mania and a bit more SZ and you are SZA.

It’s like you are Sir Mixalot with your brain chemistry and your pdoc is a Hip Hop critic.


My pdoc tells me that I’m SZA even though I almost always have some insight when symptomatic, so it sounds like our pdocs would disagree with each other.

And that said I think often times pdocs are just giving their best guess. They don’t yet have the tools to figure it out for sure half the time (not their fault).

At the end of the day I just want my medication to work, my pdoc can call me whatever she wants, although I’ll probably still give her the Borderline PD debate now and then lol.


quite a few letters…

From what you’ve described in the past anna… you have a pretty strong psychosis.

If you are capable of acting normal which you seem to be you gotta remind yourself that is all they see.

I was basically immobilized by my psychosis… left speechless and confused. Or at least that is how I felt. My SZ diagnosis wasn’t given to me until I figured out how to tell my doc what was going on and then it was instantaneous.

It’s a blurry line though. Just look at the symptoms you have. The label is negligible.

I’m no doc but I’d say you have schizophrenia. Far from disorganized or catatonic… but you’ve expressed living in a reality that not many others share. Solipsism, delusions of grandeur, hallucinations, telepathic communication… the byproducts of a fractured consciousness and/or loneliness in the world.

I am glad to see that you seem to be keeping it together very very very very well.

to make this actually relevant to the question asked…

there ain’t much difference at all. :slight_smile:

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I agree that psychosis is a spectrum, there isn’t much difference aside from insight into the delusions I think.

Yes, and your pdoc has her own bias and opinions because this whole system is run by mere humans doing what they individually decide to do/say/diagnose/prescribe… The DSM itself changes, studies change opinions, and people on this forum have varied opinions about many things as we each experience and /or study for ourselves. I truly don’t understand the need for such specificity when the real world doesn’t have that.