Can depression lead to insanity?

In this guide we are going to discuss the question “Can depression lead to insanity?” by taking a closer look to understand psychosis in people who have major depressive disorder. 

Can depression lead to insanity?

Yes, Depression, when extremely severe, can also lead to psychosis and this form of depression has been termed as “Depression with psychosis” where a person can expereincie symtksmrealted to psychosis such as hallucinations and paranoia.

Depression is a major mental health problem that can cause a major decline in a person’s quality of life. 

A person who is depressed is often unable to meet the demands of their daily lives and experiences dysfunction in various areas such as their social relationships and their occupation.

A person who is diagnosed with depression or major depressive disorder struggles with various symptoms such as feeling worthless or hopeless about themselves and their lives. They may even have physical ailments such as severe fatigue or chronic pain. 

They may be unable to focus and concentrate which may affect their ability to work and often tend to withdraw from others causing problems in their relationships. 

In most severe cases of major depressive disorder, people may struggle with suicidal ideation or may even attmept suicide leading to death. 

Link between depression and insanity

Insanity has its origins in latin meaning “unhealthy” related to a person’s mind- basically “having an unhealthy mind.” It is not a medical diagnosis but rather has been limited to legal terms in countries like the U.S. 

The term is used in the context of crime, for people who’s mental illness is so severe that they can no longer distinguish reality from fantasy and are considered not fit enough to make sound judgement because of psychosis or impulsive behaviour. 

In the medical field, insanity is no longer recognized as an appropriate term for people who experience severe mental health issues that have symptoms such as hallucinations and delusions. 

Instead, this sort of mental state where there is a clear disconnect from reality is called psychosis. 

When it comes to the question of whether depression can lead to insanity or whether depression is a form of insanity, the Diagnostic and Statistical Manual for the diagnosis of mental disorders puts forward Depression with psychosis. 

To someone who is not well-informed, a person with psychotic depression or psychosis in general is often regarded as “insane” or “crazy”.

Depression with psychosis 

This is a different subtype of Major depressive disorder where a person with depression is unable to distinguish reality from fantasy.

The person is disconnected from what is real. Depression with psychosis involves symptoms like hallucinations both visual and auditory and experience delusions of thought.

There are two types of Major depressive disorder with psychotic features: one that is mood congruent where the themes of hallucinations and delusions are related to hopelessness, worthlessness, and inadequacy. While the other one with mood incongruent psychotic features does not involve typical themes instead there could be themes of grandiosity and paranoia. 

Research finds that up to 19% of individuals who are diagnosed with severe clinical depression will develop psychotic features with rates being higher for samples who have been hospitalized. 


The symptoms Major depressive disorder with psychotic features are similar to that of major depressive disorder such as 

  • Extremely low mood
  • Lack of interest or pleasure in activities previously enjoyed
  • Fatigue or lack of energy
  • Feelings of worthlessness or hopelessness or guilt
  • Inability to concentrate and focu
  • Significant changes in weight and appetite
  • Sleep difficulties
  • Thoughts of death or suicide

However, with the added symptoms of delusions or hallucinations.

The hallucinations can be visual, auditory, olfactory, or kinesthetic- meaning that they see, feel, smell, hear things that are not real. For example, a person with this disorder might hear voices telling them they are worthless or see things that might frighten them- eg, their loved ones dying.  

These additional symptoms have them separated from reality to such a large extent that they face major risks of dysfunction. In fact, a study of out-patients with clinical depression also found that people who had psychotic depression had severe impairment in their social and work functioning.

Major risks

What makes Depression with psychotic features extremely dangerous is the high rates of suicidal ideation and suicidal attempts- Which requires people with this form of depression to be hospitalized and monitored. 

There is also dysfunction in their ability to work, not just the inability to focus or concentrate but the symptoms of hallucinations and delusions make them incapable of working.

Their social lives become problematic due to their desire to isolate which may be caused by their delusions and hallucinations leading to paranoia, extreme guilt, and feelings of worthlessness. 

This particular disorder makes them incapable of taking care of their physical needs such as food, hygiene, sleep which inturn affects their quality of life and aggravates their symptoms. 


Research has found that the causes of major depressive disorder with psychosis differ across cases, there is no one cause or factor that can lead to this disorder. However some of the causes that has been found to be related to it include:

  • Genetic disposition
  • High levels of cortisol (stress hormone)
  • Childhood trauma or early life trauma 
  • Old age

These factors may not be exclusive to each other. A person might have genetic disposition which may be triggered by trauma or high levels of stress or neurological degradation at old age. 

Side Note: I have tried and tested various products and services to help with my anxiety and depression. See my top recommendations here, as well as a full list of all products and services our team has tested for various mental health conditions and general wellness.


A person with major depressive disorder with psychotic features may be first diagnosed with depression following noticable changes in their functioning or even after a suicide attempt.

Upon examination they might be diagnosed with psychotic depression upon exhibiting behaviour symptoms shown in other psychotic disorders such as talking about hallucinations and having delusions all of which impact their quality of life. 

Diagnosis is usually done by a psychiatrist or a licensed clinical psychologist who makes sure that there is a difference between this particular disorder versus similar disorders such as Schizophrenia.


When it comes to treating this disorder there are no set guidelines or a method that has been universally accepted or FDA approved (in the US). 

Most treatment guidelines by the American Psychological association for Psychotic Depression or major depressive disorder with psychotic features recommend two thread which have been highlighted in this study,

“…either the combination of an antidepressant with an antipsychotic or ECT for the treatment of an acute episode of unipolar psychotic depression.”


The common medications used for the treatment of this disorder include antidepressant medication such as

  • SSRIs- Serotonin reuptake inhibitors 
  • SNRIs Serotonin norepinephrine reuptake inhibitors

Along with antipsychotic drugs.

Evidence suggests that treatment is more effective when there is a combination of antidepressant and antipsychotic drugs that is being administered.

Electroconvulsive therapy

This treatment is used for people who do not respond to traditional medication, it provides rapid relief and is highly suggested for people with suicidal ideation and for older people who might be at risk from the side effects of the medication. 

While there have been successes to treatment, it has to be mentioned that these treatment strategies have not been studied to a great extent meaning that we are not certain about their outcomes. 

While the treatment might be effective immediately, optimal maintenance treatment after a person responds positively to either the antidepressant/antipsychotic combination or ECT is unclear. 

Management of the disorder and strategies to prevent recurrence have not been streamlined because there is no clarity as to how long a patient needs to be on medication.  

Outcomes of treatment 

While there is a gap in research and there is more need to study the outcomes of treatment for major depressive disorder with psychotic features both in clinical and out-patient settings, it is to be said that there have been successes to treatment with good outcomes.

Outcome is more positive if treatment is not delayed, the quicker the individual receives treatment after diagnosis the more likely that treatment will be successful. 

Although treatments can reduce psychotic and depressive symptoms, the medications can also have side effects such as:

  • drowsiness
  • dizziness
  • insomnia
  • Change in weight
  • Difficulty in memory loss.

These side effects can be managed by talking to your physician about them and tailoring the dosage to requirements. 

For treatment to be effective some of the things a person can do include:

  • Persisting with medication 
  • Medication following Electroconvulsive therapy
  • Being persistent with follow up appointments
  • Engaging in talk therapy with a license professional
  • Ensuring support form family and friends
  • Engaging in assisted self care under the guidance of a professional or a legal guardian

What we recommend for Depression

Professional counselling

If you are suffering from depression then ongoing professional counselling could be your ideal first point of call. Counselling will utilize theories such as Cognitive behavioural therapy which will help you live a more fulfilling life.

Frequently asked questions related to “Can depression lead to insanity?”

What are signs of insanity?

Insanity is no longer a medically appropriate term to understand a medical illness or disorder. Insanity is often used as a layman term to label psychosis. 

Severe mental illness such as depression and schizophrenia which has been diagnosed and treated can lead to the development of psychosis and severe dysfunction. 

Some of the signs or symptoms of psychosis include:

  • Excessive fear or paranoia
  • Chronic irritability and explosive anger
  • Obsession with certain thoughts, people or things.
  • Confused thinking or brain fog
  • Detachment from reality (delusions), paranoia.
  • Inability to cope with daily problems in a healthy manner.
  • Hallucinations- visual, auditory, olfactory, kinesthetic.
  • Inability to take care of one’s physical needs such as sleep, hygiene, diet. 

Can depression mess up your mind?

The ramifications of depression on the mind and body are more severe than actually observed or generally understood. Depression can cause dysfunction in executive controls of the brain which are related to decision making, logical thinking and also other parts of the brain such as the amygdala that controls emotions. 

The disorder can affect your ability to make decisions, empathize, and be logical, it can also distort your cognition and your beliefs about yourself, the world, and other people.  

Does depression affect intelligence?

Depression is not just a feeling of deep sadness, rather it can impair various parts of your functioning- be it your job, your social life, or family responsibilities, 

It can also interrupt your ability to think. While it does not impact your IQ or your level of intelligence, It  can hamper your attention, memory and decision-making abilities.

Which may make it seem like you are unable to make autonomous decisions that are logical and adaptive, it might also make you unable to focus and concentrate which can seem like you are unable to understand others.

What age does mental illness start?

Studies have found that there is a large percentage of people who struggle with mental illness at a young age- as young as six years old for children with ADHD and learning disabilities or autism.

While another common age bracket includes 14-25 when the life experiences and transitions tend to be profound for young adults and adolescents. 

The age of onset can change according to genetic disposition, biological conditions, and life experiences such as trauma.

Is feeling crazy normal?

The feeling of “going crazy” could truly stem from a developing mental illness. You might be referring to this feeling as unable to control your emotions, your thoughts, and your behaviour. 

It might also refer to seeing things that are not there and having beliefs that people might call “crazy”.

All of these signal a possible mental disorder which requires medical attention and is not generally the norm of other healthy people however, it is a common occurrence. . 

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