When I started my first little 'commentary' on depression, I intended to create a series looking at different types of depression and generally trying to look at all aspects of the illness. But you know how it is- life gets in the way, school infiltrates your free time. So here I am, months later, finding that I do in fact have more to say. The response to my last essay was wonderful- it was good to see that there are people who do think about these things and who want to learn more about the subject.

One thing that worried me slightly was that the essay made some people think that they are "more depressed than they thought". I really feel I should stress that it is not the sheer number of symptoms alone, which creates depression. Depression is a fluid thing, it fluctuates, and no mere list can tell you what you are or what you aren't. If you feel that you could be depressed then you should seek advice and help from the professionals. I'll repeat that: from the professionals. Self-diagnosis is unreliable; on psychology courses you inevitably get students finding symptoms where there are none and panicking because they think they have schizophrenia. The safest and best thing to do is go to a doctor, a psychiatrist, anyone who can help you.

Being a teenager by definition means that you probably will go through periods when you feel you are depressed. In some cases it may just be "the hormones" or simply the stress of having to leave your childhood behind, do exams, get a job etc etc etc (argh!) but to avoid becoming a statistic, always seek help for any worries you have about your mental health. And make sure you're taken seriously- I know too many people who have mental health issues who weren't given the help they needed. If you need to, be persistent, bombard the system- get the help that is your right.

Now then, introduction over. I'd like to talk about something that perhaps some people haven't heard of or actually don't know that much about: Psychotic Depression. I must point out that if you're well enough to be sitting down and reading through this, it is HIGHLY unlikely that you suffer from Psychotic Depression. Why write this essay?

A lot of people think that people who suffer from Psychotic Depression are "nutters" or "loonies" or schizophrenics when in fact they're none of these.

Psychotic Depression is difficult to diagnose because people who suffer from the illness are often ashamed and embarrassed- it's nothing to be ashamed of.

Roughly 25 of people admitted into hospitals from depression suffer from Psychotic Depression- this is a significant amount.

So, what is psychotic depression, actually? Well, in addition to the symptoms of depression (which you can see in the first essay), psychotic depression includes some features of psychosis such as:

Hallucinations (seeing things that aren't there or even hearing, feeling, tasting or smelling things that aren't there) and delusions.

This is actually also common in people living with schizophrenia however unlike schizophrenia people with psychotic depression are usually aware that what these thoughts aren't true- this is where the shame comes from. Here's a quote from someone (called 'X' here) who suffers from psychotic depression: "I had started to feel things too, by that stage. Things grabbing at me, pain, and I could taste bitterness in my mouth. It was too real… it invaded everything; my hearing, what I saw. In the end you don't know what's real and what isn't and that's what is scariest- you don't know what to trust and I'll never know how much of it was me, and how much was actually there."

Psychotic depression increases your RISK of bipolar depression, relapses into psychotic depression and worryingly, of suicide.

There are symptoms of Psychotic Depression, just as with normal depression. These are:

Anxiety

Agitation

Hypochondria

Insomnia

Physical immobility

Constipation

Intellectual impairment

These symptoms alone don't mean that you have Psychotic Depression- you also need the bit about hallucinations and delusions.

Now, Psychotic Depression is nothing to be ashamed about. In the past year I have started talking to someone who suffers from the illness (part of my motivation for writing this essay) and have learned a lot about my own lack of knowledge and about people who suffer from severe mental illnesses. The person I've been chatting with is male and in the 18-25 age range (I really don't want to reveal his name here, that would be harsh. Mr. X). He had dysthymia, which developed into psychotic depression. Some sources say "Treatment is very effective for psychotic depression, and people are able to recover, usually within a year, but continual medical follow-up may be necessary." X would also like me to add that support networks are inadequate at best, and in his experience, understanding of his illness has been low.

Psychotic Depression is associated with self-harm, suicide and hospitalisation- far more than with nonpsychotic depression. Patients usually have "troubled" lives, with difficult relationships with others. Relapse rates are from 50 to 92 and recurrence most often develops within 2-14 months. So you see, this isn't regular depression- this is basically something awful- serious mental illness. It would be easy to dismiss people who suffer from psychosis as "loonies" but when talking to X you really cannot make yourself see a "loony". He is an individual: intelligent, witty, scarily sarcastic and completely bitter about the way that he's been treated by 'the system'. I've never met anyone who can joke about such a bad situation.

"Treatment for psychotic depression requires a longer hospital stay and close follow-up by a mental health professional. Combinations of antidepressants and antipsychotic medications have been most effective in easing symptoms. Electro convulsive therapy (ECT) may also be used to treat psychotic depression." – X says that "I took my medication because I was terrified of the electro therapy. There was no way they were getting my into that chair, you know. No way in hell." I myself hate the idea of electro convulsive therapy… it sounds so barbaric and honestly, I have no idea if it actually works. It all sounds very depressing (pun intended) but there is light, I suppose, at the end of the tunnel.

X is not currently in an episode of Psychotic Depression. He lives in constant fear of a relapse, and takes his medication every day to try and minimise the chance of it happening. He also goes to a psychiatrist every week. He says that he isn't "cured", he is still ill, but now he can ignore it to a certain degree. Treatment, apparently, is hard. The side effects of antipsychotics and antidepressants are dizziness, headaches, nausea, anxiety and aggression and back pain. It can also go either way as to whether the medication puts X to sleep or makes him hyperactive. And honestly, he's very happy with all his side effects and mood swings. The "improved quality of life" has been turned on its head: X doesn't just have improved quality of life, he has a life which he has built for himself and which he actually wants to live.

So, from self-harm, hospitalisation and attempted suicide to this, something that I specifically asked to be allowed to put in here: "You know I'm actually sort of happy right now. I got laid, which is always good. Go me! Ahem. You know I'm always scared of buying 'protection' (oh god) myself because the lady in the co-op thinks I'm really sweet and innocent right now and I don't want to ruin her little fantasy world." In other words- Psychotic Depression is hell; it's a world inside your head, which is actually something like hell. I don't want to think about the things that X went through to come out of the other side but I should. We all should. We need to understand this- people with Psychotic Depression are not lost causes; they are not "nutters". They're people who were happy- they have families and jobs and sex lives and dogs to take for walks- and they'd like to get back to them.