Psychotic symptoms and vulnerability to recurrent major depression

The demographic characteristics and psychiatric course of primary unipolar depressed patients, either with or without psychotic features, were compared in a retrospective study. 15% (25/165) of the patients had had at least one episode of psychotic depression. Compared with the 140 non-psychotic patients, the psychotic patients were more likely to be female, had been ill for significantly longer and endured significantly more episodes of depression. The greater number of episodes was not attributable to the greater length of illness. Various reasons for the group differences are examined. Particular consideration is given to the possibility that a propensity for recurrent psychotic major depression might be related to sensitized dopamine neurons.