Psychotic depression

Major depressive disorder (MDD) stands as the third leading cause of disease burden worldwide, a position projected to escalate to the top spot by 2030, according to the World Health Organization. In the UK, depression ranks as the third most common reason for consulting with a GP. This article focuses on one of the most severe manifestations of depression/psychotic depression, also known as MDD with psychotic features which represents the extreme end of the depressive spectrum, characterised by the co-occurrence of psychosis in the context of severe depression. However, despite its clinical severity, it is often underdiagnosed and undertreated. This article aims to guide assessment and diagnosis of patients in primary care, covering key aspects including aetiology, clinical presentation, referral pathways, management strategies, and prognosis.