Depression And Schizophrenia Symptoms: Related Mental Health Conditions
- For those experiencing suicidal thoughts, please contact the 988 Suicide & Crisis Lifeline at 988
- For those experiencing abuse, please contact the Domestic Violence Hotline at 1-800-799-SAFE (7233)
- For those experiencing substance use, please contact SAMHSA National Helpline at 1-800-662-HELP (4357)
Although schizophrenia and depression are classified in separate categories within the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it isn’t uncommon for individuals with schizophrenia to also experience symptoms of depression.
The reasons why these disorders sometimes co-occur aren’t fully understood, but research is ongoing, and scientists are making progress in determining the connection between the two. Ultimately, this information might reveal more effective treatments for both disorders. Currently, a combination of therapy and doctor-prescribed medication tends to be one of the most common treatments for both depression and schizophrenia.
Schizophrenia
Schizophrenia can be considered a somewhat uncommon mental illness, affecting roughly 0.32% of the global population. Schizophrenia is often a chronic and severe condition that typically presents in the late teens to early thirties and can be characterized by distorted thinking, hallucinations, delusions, and abnormal social behavior.
Psychotic symptoms of schizophrenia
Psychotic symptoms, also referred to as “positive” symptoms, usually distort one’s experiences, affecting how the individual thinks, acts, and perceives the world. They may be alienating and isolating as they typically disconnect one from the reality that most people share. They generally include the following:
- Delusions can be defined as irrational, illogical, false beliefs to which the individual adheres despite evidence to the contrary. People experiencing delusions might believe they’re receiving messages telepathically or from the TV or radio. The delusions could be rooted in paranoia, with the individual thinking that others want to hurt them or are “out to get” them.
- Hallucinations generally refer to the experience of hearing or seeing things that aren’t there. People can experience other sensory hallucinations related to taste, touch, or smell, but these tend to be less common.
- Disorganized thoughts and speech can be seen as illogical, disjointed thought patterns that typically manifest in the way one speaks. Individuals presenting this symptom might have difficulty communicating with others, or they might talk to themselves or others who aren’t there. They might jump randomly between topics, stop talking in the middle of a thought, or string together random or made-up words (sometimes referred to colloquially as “word salad”).
- Severely disorganized behavior or catatonia can refer to abnormal, sometimes repetitive body movements. In rare cases, the individual may display catatonia that manifests as ceasing to speak or move for extended periods of time.
Negative symptoms of depression and schizophrenia
This category generally includes symptoms that directly impact mood and function, and many of these overlap with symptoms of depression. Someone with negative symptoms might experience a loss of motivation or interest and pleasure in daily activities. They may have difficulty expressing their emotions and become isolated and withdrawn from others.
Those with negative symptoms might struggle with daily responsibilities like paying bills or caring for themselves. They may exhibit other depressive symptoms, such as low energy, avoidance of activities they once enjoyed, or a lack of desire to engage with others in social settings, leading to social withdrawal or social isolation.
Cognitive symptoms of schizophrenia
Cognitive symptoms typically refer to those affecting an individual’s memory, concentration, and attention. They might make it difficult to follow directions, learn new things, or remember important information. People with cognitive symptoms might have trouble using and processing information to complete tasks or make decisions. They may also have difficulty paying attention or focusing.
Diagnostic criteria of depression and schizophrenia disorder
According to the guidelines set by the DSM-5, to receive a schizophrenia diagnosis, one must present at least one of the three primary symptoms (delusions, hallucinations, and disorganized speech) plus at least one other core symptom for a significant period over one month. If successfully treated, individuals may display symptoms for less than one month and still receive a diagnosis.
The symptoms must result in diminished function in primary areas of daily living, including work, school, interpersonal relationships, and self-care.
Diagnostic criteria also dictate that schizoaffective, bipolar, and depressive disorders must be ruled out as potential sources of the symptoms. This generally means that there are no concurrent major depressive or manic episodes with the active-phase symptoms. If mood episodes do occur concurrently, they must appear minimally during active or residual phases. In general, the symptoms must not be related to the physiological effects of substance misuse or other medical conditions.
Major depressive disorder
Depression, also known as major depressive disorder, major depression, or clinical depression, is a common and serious mood disorder that can cause severe symptoms affecting how you feel, think, and handle daily activities. It is estimated that worldwide, roughly 5% of the adult population has depression.
Types and symptoms of depression
There are several types of depression, some of which may come and go according to circumstances, such as seasonal affective disorder (SAD) and perinatal depression.
Aside from major depression, persistent depressive disorder (sometimes called dysthymia) tends to be the most common type. It is usually characterized by less severe depressive symptoms lasting for two years or longer. It may be relevant to note there is a specific form of depression (psychotic depression) that features symptoms of psychosis, like delusions and hallucinations.
Core symptoms of depression and schizophrenia usually include the following:
- Persistent sadness and/or anxiety
- Hopelessness or believing that life is meaningless
- Feelings of guilt, shame, or worthlessness without reason
- Irritability, restlessness, and frustration
- Loss of pleasure in activities one previously enjoyed
- Lack of energy, fatigue, and sluggishness
- Difficulty with memory and concentration
- Changes in sleep and appetite
- Physical discomfort like headaches, muscle aches and pains, and digestive problems
- Suicidal ideation, suicidal behavior, and/or preoccupation with thoughts of death
If you or someone you know is struggling or in crisis, help is available. Text or call 988 or chat 988lifeline.org. Support is available 24/7. If you are experiencing trauma, support is available.
Diagnostic criteria for depressive symptoms
To qualify for a diagnosis of depression, individuals must present five or more of the above symptoms, and these symptoms must cause significant distress or problems with daily functioning at work, school, home, in interpersonal relationships, and in other situations. The symptoms cannot result from a medical condition or the physiological effects of a substance.
The criteria also state that the individual must never have had a manic or hypomanic episode, and the symptoms may not be better explained by schizophrenia or other psychotic disorders.
The connection between depression and schizophrenia
Symptom similarities of schizophrenia and depression
Some of the symptoms of schizophrenia and depression are so similar that it can be possible for one disorder to be misdiagnosed as the other. These most commonly include negative symptoms of schizophrenia, such as the loss of interest in activities one used to find enjoyable or feelings of emptiness and hopelessness. Negative symptoms in schizophrenia, such as poor self-concept, shame, and self-distrust, can also be common in individuals with depression. Both disorders may involve cognitive symptoms like trouble with concentration and memory.
Risk factors of schizophrenia and depression
Schizophrenia and depression might also share some of the same risk factors. For example, early trauma and neglect are frequently associated with early-onset symptoms in people with schizophrenia and depression.
Social adversity and bullying have also been suggested as potential risk factors for both schizophrenia and depression.
Genetics
Several studies have found that individuals with a family history of schizophrenia usually have an increased risk of developing depression and vice versa. This suggests that there may be shared heritable vulnerabilities between the two disorders. However, having a family history of one disorder does not guarantee the development of the other.
Studies have identified common genetic variants associated with both schizophrenia and depression. These studies have also revealed genetic overlap between the two disorders, although the specific genes and their exact roles are still being investigated.
Neurological commonalities
Dysfunction in some regions of the brain may also influence a connection between schizophrenia and depression. For example, studies indicate that individuals with schizophrenia, bipolar disorder, and major depressive disorder “share common neurobiological disruptions and neural structural distinctions between these disorders may be less prominent than initially postulated.”
Negative outcomes
Studies indicate a pattern of similar adverse outcomes associated with untreated comorbid major depression and schizophrenia. For example, substance use disorders tend to co-occur more frequently with depression and schizophrenia, as well as anxiety and personality disorders. In addition, individuals with psychotic disorders like schizophrenia and people with depressive disorders are often at an increased risk for suicidal ideation, suicide attempts, and completed suicide, as are individuals with bipolar disorder and substance use disorders.
Research on comorbid depression schizophrenia disorder
To further illustrate similarities in poorer outcomes, a 2020 study published in Biomedical Central measured the prevalence of depression among schizophrenia patients in Ethiopia. Their findings revealed that “comorbid depression was high among people with schizophrenia and associated with current substance use, suicide attempt, and long duration of the illness as well as poor quality of life.”
Schizoaffective disorder
When depression and schizophrenia symptoms occur together, this is sometimes referred to as "schizoaffective disorder." Schizoaffective disorder affects approximately 0.3% of people in the US and usually features a combination of schizophrenia, major depressive, or bipolar symptoms. There are two types classified by symptom presentation:
- Schizoaffective bipolar type is normally characterized by episodes of mania, sometimes alternating with major depression, along with positive schizophrenia symptoms.
- Schizoaffective depressive type typically involves major depressive symptoms without mania, along with positive schizophrenia symptoms.
Mental health treatments for people with schizophrenia depression
Treatment for depression and schizophrenia typically involves a combination of medication, psychotherapy, and other forms of support. Plans are usually tailored to the individual’s needs based on symptoms, medical history, and response throughout the treatment process.
Medication and its effects on symptoms of schizophrenia
Depending on an individual’s diagnosis and symptoms, medications like antipsychotics, mood stabilizers, and antidepressants may be prescribed. Please consult your doctor or psychiatrist with any questions about medication options and speak to them before starting, stopping, or changing the way you take medication. The information in this article is not a substitute for medical advice.
Therapeutic mental health interventions for schizophrenia and depressive disorder
Also known as talk therapy, psychotherapy is often the first-line treatment for depression. While medication is usually the first-line treatment for schizophrenia, psychotherapeutic techniques can also be beneficial. Psychotherapy typically comes in several forms that aim to help individuals with mental health conditions explore the thoughts, feelings, and behaviors contributing to the condition.
Cognitive behavioral therapy (CBT)
The most used form of treatment for both schizophrenia and depression, CBT generally focuses on identifying the thought patterns and emotions that create distress in the individual’s life. Once these are isolated, the therapist and client can work together to reframe these thoughts differently to make them more manageable and based in reality.
CBT can help individuals process and manage emotions, solve problems in daily life, and reduce stress.
While it isn’t necessarily appropriate in every case, research indicates that internet-delivered CBT can be effective for some people with depression and schizophrenia.
Online mental health treatment for depression and schizophrenia
Online therapy platforms can eliminate geographical barriers to treatment, often providing a higher level of connection to a larger pool of mental health professionals experienced in treating depression and schizophrenia. Virtual therapy typically allows individuals to attend appointments from the comfort of their homes on a convenient schedule via video, phone, or online chat.
Family education and support
Involving family members in treatment can be beneficial, as education about the illness and family therapy can help families better understand schizophrenia and learn how to provide appropriate support.
Psychosocial programs
Programs that provide social support, vocational training, and assistance with daily living skills can help individuals with schizophrenia live more independently and improve their quality of life. Peer-to-peer counseling facilitated by someone with schizophrenia trained to support others, support groups for individuals with schizophrenia facilitated by a mental health professional, and occupational therapy designed to improve daily productivity can all serve as examples of psychosocial programs.
It may be prudent to mention that recent reports suggest that the United States government’s National Institute of Mental Health (NIMH) has reduced its support for treatment trials for schizophrenia, bipolar disorder, and major depressive disorder over the past few decades. The decline in support for schizophrenia treatment trials may delay further research and development of newer and more effective treatments. With time and increased funding, people with schizophrenia and major depression may benefit from greater progress in treatment options.
Takeaway
What are the risk factors of schizophrenia?
Several risk factors can put a person at an increased risk of developing schizophrenia. These risk factors include:
Substance misuse
Environmental factors
Genetics
Developmental factors
Brain structure and chemistry
How does schizophrenia affect a person’s mental health in the long term?
Schizophrenia is a serious mental illness that requires ongoing mental health treatment. Untreated schizophrenia may result in an increased risk for lifelong problems and complications, including:
Severe depression and mood symptoms
Anxiety disorders
Social withdrawal or social isolation
Suicidal thinking, suicidal behavior, and completed suicide
Heart disease
Decreased subjective quality of life
What is the difference between schizophrenia and schizoaffective disorder?
Schizoaffective disorder differs from schizophrenia in that it may include more pronounced affective symptoms similar to those of mood disorders. Schizoaffective disorder can be challenging to diagnose due to its similarities to other affective disorders. Disorders that mental health professionals rule out when diagnosing schizoaffective disorder include the following:
Schizophrenia: For a diagnosis of schizoaffective disorder, there must be at least a two-week period of positive symptoms, such as delusions and hallucinations, without manic or depressive episodes. However, mood symptoms (i.e., mania or depression) must be present for the majority of the duration of the illness. If psychotic symptoms are more dominant than affective symptoms during the duration of the illness, the diagnosis may lean toward schizophrenia. Prodromal symptoms may also be present during the early course of schizophrenia, but they are not a requirement for schizoaffective disorder.
Bipolar disorder with psychotic features: In bipolar disorder with psychotic features, psychotic symptoms are only present during manic episodes. This doesn’t meet the two-week period of only psychotic symptoms required for a schizoaffective disorder diagnosis.
Major depressive disorder with psychotic features: MDD with psychotic features, also called psychotic depression, is a form of severe depression accompanied by psychotic symptoms. Unlike schizoaffective disorder, people with MDD with psychotic features only experience psychotic symptoms during depressive episodes. This also differs from post-psychotic depression, a condition in which an individual experiences depressive symptoms following a psychotic episode.
What are the risk factors for schizoaffective disorder relapse?
Risk factors for schizoaffective disorder relapse may include:
Comorbid mental disorders
Social withdrawal or social isolation
Stopping antipsychotic medications
Stress
Disruptions in routine
Substance abuse
Is a major depressive disorder permanent?
Major depressive disorder is a chronic mood disorder, but it is not considered permanent. Even severe depression symptoms can be managed successfully through psychotherapy and antidepressant medication. Many types of therapy for depression utilize a cognitive approach to address depressive symptoms. Cognitive-behavioral therapy (CBT), an effective mental health treatment for mild to severe depression, combines a cognitive approach with a behavioral one, focusing on negative thought patterns and behaviors and how they may exacerbate mood symptoms in depressed patients. CBT is also often used to treat anxiety disorders, affective disorders, and other types of mental and behavioral disorders.
How do people with schizophrenia cope with their symptoms?
Treatment for chronic schizophrenia may involve a combination of medication, therapy, and self-care. Relaxation techniques can also help address the increased sensitivity and emotional regulation issues that people with schizophrenia often experience. Psychosocial support and lifestyle changes can also help schizophrenia patients manage their negative and positive symptoms.
Drug treatment for psychotic symptoms may involve typical or atypical antipsychotics. Both typical and atypical antipsychotic agents can be effective in treating positive symptoms of schizophrenia, but atypical antipsychotics may be more effective for negative symptoms, such as blunted affect, social isolation, and anhedonia. Certain atypical antipsychotics may have antidepressant effects that can help reduce mood symptoms.
Are depression and schizophrenia linked?
Yes. According to a systematic review published in the Schizophrenia Bulletin, people with schizophrenia are more likely to experience depressive episodes compared to the general population. Schizophrenic patients may also develop post-psychotic depression as a psychological reaction following a psychotic episode. The post-psychotic depression symptoms experienced by people with schizophrenia may be so severe that they meet the diagnostic guidelines for major depressive disorder outlined in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders.
Another systematic review published in the Schizophrenia Bulletin suggests that depression may be linked to an increased risk of first-episode schizophrenia in individuals identified as ultra-high risk (UHR) for psychosis. There is also a form of affective psychosis known as psychotic depression, or depression with psychotic features, that causes a person to experience psychotic symptoms alongside low mood and other depressive symptoms. Affective psychosis can also accompany a diagnosis of depressive disorder or bipolar disorder with psychotic features.
Comorbid depression and schizophrenia are often assessed using the Calgary Depression Scale. The Calgary Depression Scale is a nine-item scale that measures depression levels in individuals with non-affective psychosis, distinguishing depressive symptoms from negative symptoms of schizophrenia, such as blunted affect and social withdrawal. Differential diagnosis may be critical, especially in young people. Moreover, brain imaging studies suggest similar parts of the brain are affected by both depression and schizophrenia. Genetics may also play a role in comorbidity, though further research is needed to study candidate genes. Treatment trials are ongoing to determine how to best treat individuals with both schizophrenia and depression.
Can a person with schizophrenia live a happy life?
Yes. According to the American Psychiatric Association, there is increasing evidence that people with chronic schizophrenia can live fulfilling lives despite their mental health diagnosis. Ongoing treatment through psychotherapy and medication, such as typical and atypical antipsychotics, can help individuals with chronic schizophrenia manage their positive and negative symptoms and function more independently. Leaving schizophrenia untreated may lead to harmful consequences, including financial instability, social isolation, reduced quality of life, suicidal thinking, and completed suicide.
A 2022 systematic review published in the Schizophrenia Bulletin looked at 75 randomized controlled trials from 1959 to 2017 and found that continued use of typical or atypical antipsychotic agents as maintenance treatment may aid schizophrenic patients by preventing relapse and improving quality of life, and that withdrawing antipsychotic drugs may result in poorer outcomes.
How can you calm down a schizophrenic episode?
To calm a psychotic episode related to schizophrenia, schizoaffective disorder, or another mental illness with psychotic symptoms, it can be helpful to get to a safe and comfortable place, talk to the person calmly, and distract them with a relaxing or enjoyable activity.
How does a person with schizophrenia feel?
A person with schizophrenia may feel a range of negative emotions, including frustration, anger, and confusion. This is a common psychological reaction with mental and behavioral disorders. Still, an early course of treatment can help people manage their symptoms. Individuals with schizophrenia may also experience low mood and other depressive symptoms. In a study on symptom patterns among chronic schizophrenic in-patients, over a third of participants reported depressive symptoms and affective states.
Thanks for the feedback!
- Previous Article
- Next Article