Post-Psychotic Depression: An Updated Review of the Term and Clinical Implications

Abstract

<b><i>Background:</i></b> Post-psychotic depression (PPD) is an important and frequent clinical phenomenon featuring controversial complexity in its nosological and aetiopathogenic cataloguing. <b><i>Objectives:</i></b> The main objective of this research was to review the published literature on PPD. The second objective was to indicate its clinical importance, either comorbid or as an entity of its own. To answer these questions, a historical review of the term is made and a search about the clinical, evolutionary, predisposal, and prognostic variables that characterize the PPD. <b><i>Methods:</i></b> The international recommendations were followed according to the Preferred Items for Reporting of Systematic Reviews and Meta-Analyses (PRISMA). The databases used were Web of Science and PubMed, with the deadline for the inclusion of articles in November 2019. The MeSH used were the following: “post” AND “psych *” AND “psich” AND “depr.” <b><i>Results:</i></b> The search resulted in 64 articles. Only 19 of these met the pre-specified inclusion criteria and were finally included in the review. One article found that reading this literature was added due to its relevance. Despite its high prevalence (around 30%), there is little research about the term PPD. Nevertheless, results show data to improve the description of the syndrome, revealing differential characteristics from other depressive symptoms in chronic psychosis due to its clinical implications. <b><i>Conclusions:</i></b> Coinciding with the latest classification manuals that do not include the term, there appears to be an abandonment of its use despite its high prevalence. Data suggest that PPD is a nosological entity different from a secondary effect to antipsychotics, the negative symptoms of psychosis, and other clinical disorders that combine psychotic and depressive symptoms such as bipolar disorder, schizoaffective disorder, or depression with psychotic symptoms. PPD also has differential characteristics concerning further depressive symptoms, especially important clinical implications such as higher suicide risk and poorer quality of life.

A case of postpsychotic depression improved by switching antipsychotic monotherapy

“…Postpsychotic depression requires careful differential diagnosis, is frequent, and is characterized by psychological rather than behavioral features compared to depression 6 . Suicide is a risk factor of PPD 6 .…”

“…Postpsychotic depression requires careful differential diagnosis, is frequent, and is characterized by psychological rather than behavioral features compared to depression 6 . Suicide is a risk factor of PPD 6 . Regarding pharmacotherapy, since the base of PPD is schizophrenia, we prefer continued administration of antipsychotics, which may improve depressive symptoms 7 .…”

“…6 Suicide is a risk factor of PPD. 6 Regarding pharmacotherapy, since the base of PPD is schizophrenia, we prefer continued administration of antipsychotics, which may improve depressive symptoms. 7 In contrast, a Cochrane review by Whitehead et al 13 concluded that concomitant use of antidepressants did not significantly reduce depressive symptoms.…”

“…Mino and Ushijima 5 refer to PPD as a “postpsychotic collapse” and indicate that it is a state of inactivity with a loss of energy and vitality after the improvement of psychotic symptoms. In his latest review, 6 Guerrero stated, “We have always focused on hallucinatory delusions in patients with schizophrenia, but in the last two decades we have begun to reaffirm the importance of the emotional aspect as part of the recovery process in psychotic patients.”…”

Delusional Infestation: A case of Ekbom syndrome in an elderly woman with a long history of HIV

“…Perhaps the most intriguing observation is the onset of depressive symptoms soon after the resolution of psychotic symptoms as a condition that may be referred to as post psychotic depression (17). Albeit having a five-year history of psychosis, a first-episode psychosis(FEP) has a notably higher incidence rate (50%) of post-psychotic depression compared to non-first-episode psychotic patients (18).…”