By Dr. David Woo - July 4, 2022

Depression is one of the most common mental health conditions in the US, affecting roughly 21 million adults.(1) Depression affects how someone feels, thinks, and can even impair their ability to perform daily tasks. Some people with severe depression may experience delusions and hallucinations, symptoms of psychosis. When patients with a primary diagnosis of major depressive disorder (MDD) also experience psychotic symptoms, this is referred to as psychotic depression.(2,3) 

Psychotic Depression – When Depression Patients Also Have Symptoms of Psychosis

Symptoms of Psychotic Depression

People with psychotic depression show symptoms of both depression and psychosis.(2,3)

Depression affects one’s emotions, cognition, and behavior, and is characterized by numerous symptoms, including:

• Sadness, irritability, and anxiety
• Loss of interest in activities that one used to enjoy
• Lethargy
• Irregular sleep
• Feelings of guilt or worthlessness
• Cognitive issues, such as difficulty with memory or focus
• Suicidal thoughts (4)

Psychosis may occur episodically, meaning that symptoms may be present in some moments and absent in others.(2) Psychosis is associated with:

• Delusional behavior: Believing and reacting to things that aren’t true or aren’t based in reality
• Hallucinations: Unreal sensory experiences that appear to be real and can affect any of the five senses, such as seeing things that aren’t there

In addition to the symptoms listed above, psychotic depression may also result in:

• Psychomotor impairment: Occurs when there is a disruption between the mental and muscle functions of the body, which can affect the way someone talks or moves.
• Stupor: An unresponsive state of near-unconsciousness(5)

How Often Does Psychotic Depression Occur?

Roughly 10-19% of adults experiencing a depressive episode also have psychotic symptoms.(6) In elderly patients hospitalized for depression, as many as 53% display psychotic symptoms.(7)

While we don’t know exactly what causes psychosis in people with depression, researchers are working to understand the relevant differences between depression patients who experience psychotic symptoms and depression patients who don’t. For instance, childhood trauma, a predictor of clinical depression, is 2 to 15 times more prevalent among those with psychotic depression than those without psychotic symptoms.(8)

Treatment for Psychotic Depression

Psychotherapy (Talk Therapy)

While talk therapy may not relieve symptoms of psychosis, certain types of talk therapy, like cognitive behavioral therapy (CBT), have proved to help patients with psychotic depression cope with and accept their diagnosis.(9)

Medication

Standard treatment for patients with psychotic depression typically involves antidepressant and antipsychotic medications. Taken together, these prescriptions generally help to reduce the severity of both depressive and psychotic symptoms.(3)

Electroconvulsive Therapy (ECT)

ECT is a method that is administered to patients under anesthesia where electrical impulses are delivered to the brain. It is a highly effective form of therapy offered to individuals with severe MDD who are unresponsive to medication and other therapies.(10)

Transcranial Magnetic Stimulation (dTMS)

Transcranial magnetic stimulation (dTMS) is a non-invasive treatment option that uses magnetic pulses to regulate overactive and underactive regions of the brain. A literary review of multiple published studies, shows that TMS could be effective in reducing symptoms of psychosis, such as hallucinations and delusions.(11)

Women and mental health is a critical topic that deserves attention, as research shows that women are more susceptible to certain mental health conditions, such as depression, compared to men. Women often face unique challenges related to hormonal changes, gender roles, and societal expectations that can impact their mental well-being. Additionally, women’s mental health issues can manifest differently, and they may encounter barriers or discrimination when seeking treatment. At Madison Avenue TMS & Psychiatry, we are committed to providing compassionate care and effective treatment options tailored to the specific needs of women, including talk therapy, medication management services, and transcranial magnetic stimulation (TMS). Let´s break down the state of women’s mental health issues today, and how innovative treatments can help patients overcome traditional barriers to wellness.

Jump to:

• Are Women More Susceptible To Certain Mental Health Conditions?
• Do Women Manifest Different Mental Health Symptoms?
• Gender Differences In Symptoms Of Mood Disorders
• Barriers Women Face In Mental Health Treatment
• Treatment Options For Women’s Mental Health Issues
• Get Compassionate Mental Health Care At Madison Avenue TMS & Psychiatry

Are Women More Susceptible To Certain Mental Health Conditions?

Studies indicate that women are more likely than men to experience certain mental health disorders. This discrepancy between the sexes is influenced by a combination of biological, psychological, and social factors. Key statistics include:

• Depression: Women are nearly twice as likely to be diagnosed with depression compared to men (1, 2). Hormonal fluctuations during puberty, menstruation, pregnancy, postpartum, and menopause can contribute to this increased risk.
• Anxiety Disorders: Women are more likely to experience anxiety disorders, including generalized anxiety disorder (GAD), panic disorder, and phobias (4).
• Post-Traumatic Stress Disorder (PTSD): Women are more than twice as likely as men to develop PTSD after experiencing traumatic events. Women are also more likely to experience certain types of trauma, such as sexual violence, which further increases the risk of PTSD (5).
• Obsessive-Compulsive Disorder (OCD): OCD affects both men and women, but women tend to have a later onset and are more likely to develop OCD related to contamination fears and compulsive cleaning (6, 7).
• Attention-Deficit/Hyperactivity Disorder (ADHD): ADHD is often underdiagnosed in women, who may present with inattentive symptoms rather than hyperactivity. As a result, many women remain undiagnosed until adulthood (8).
• Bipolar Disorder: Women are more likely to experience rapid cycling (more frequent mood changes) and mixed states of bipolar disorder compared to men, making it essential to identify gender-specific symptoms and treatment plans (9).
• Borderline Personality Disorder (BPD): Approximately 75% of those diagnosed with BPD are women, with symptoms often linked to trauma, emotional instability, and interpersonal difficulties (10).

Do Women Manifest Different Mental Health Symptoms?

Women’s mental health issues often manifest differently compared to men, which can impact diagnosis and treatment. Mental health is not one-size-fits-all, and symptoms can present across the entire gender spectrum. However, women as a demographic display some differences in symptoms in certain conditions, such as:

• Depression: Women with depression may experience more physical symptoms such as fatigue, changes in appetite, and sleep disturbances, while men may report more irritability and anger.
• Anxiety: Anxiety in women often manifests as internalizing symptoms like excessive worry, phobias, rumination, and physical complaints (e.g., headaches, fatigue), whereas men tend to present externally, with a higher prevalence of irritability and risky behaviors.
• PTSD: Women are more likely to experience symptoms such as hypervigilance, avoidance, and emotional numbing, while men may exhibit higher levels of aggression.
• ADHD: Women with ADHD often show inattentiveness, forgetfulness, and disorganization, which can be mistaken for anxiety or depression.
• Bipolar Disorder: Women with bipolar disorder tend to have more depressive episodes and fewer manic episodes than men, which can affect how the disorder is perceived and treated.
• OCD: Women are more likely to develop OCD symptoms related to caretaking, contamination, and morality.

Hormonal changes in women, including pregnancy and the menstrual cycle, may also account for variations in symptoms. Pregnant women, new mothers, and pre- and post-menopausal women all experience changes in their body chemistry that can affect their vulnerability to certain mental health disorders as well as the presentation and severity of symptoms. It´s important to note that hormonal factors should not be an excuse for anyone to dismiss or minimize mental health symptoms—our mental health is intimately linked to our biochemistry, and hormones are a natural part of that.

Gender Differences In Symptoms Of Mood Disorders

This table presents an overview of gender-based differences in symptom manifestation in common mental health conditions:

Barriers Women Face In Mental Health Treatment

Despite the higher prevalence of mental health disorders among women, many face significant barriers to accessing effective care due to the negative impacts of sexism and societal expectations of women (11).

• Misdiagnosis: Women are often misdiagnosed or have their symptoms attributed to hormonal changes or emotional overreaction, leading to delayed or inadequate treatment.
• Financial and time constraints: Caregiving responsibilities and lower income levels can prevent women from seeking timely mental health care.
• Gender discrimination: Some women report experiencing discrimination in the healthcare system, where their concerns are not taken seriously or dismissed, impacting their willingness to seek treatment.

Treatment Options For Women’s Mental Health Issues

At Madison Avenue TMS & Psychiatry, we offer a range of treatment options designed to address women’s mental health issues. These include:

• Medication management: Personalized treatment plans to manage conditions such as depression, anxiety, ADHD, and bipolar disorder
• Telehealth consultations: Convenient access to mental health care from the comfort of home, making it easier for women to prioritize their mental well-being.
• Transcranial magnetic stimulation (TMS): A non-invasive and effective treatment option for depression, OCD, and anxiety, particularly for those who have not responded to medication or therapy. 

As a drug-free depression treatment, TMS is safe for women who want to avoid the potential pharmaceutical interactions and side effects that come with taking antidepressants. This means that TMS is an effective treatment to undergo for women who are pregnant, breastfeeding, or on hormonal medications for birth control, menopause, or other reasons.

Get Compassionate Mental Health Care At Madison Avenue TMS & Psychiatry

Women face unique challenges when it comes to mental health, but effective treatments are available.

At Madison Avenue TMS & Psychiatry, we provide compassionate care tailored to the specific needs of women in a supportive environment. Our clinic stands for gender equality and mental health equity, and we encourage women with mental health concerns to contact us for a consultation without fear of discrimination or judgment.

If you or a loved one is struggling with mental health issues and based in the New York area, contact us today via our website or by calling (212) 731-2033. Our team of professionals is here to help you regain control of your mental well-being and lead a healthier, more fulfilling life.

More Resources On Women And Mental Health:

• Understanding Menopause Mood Swings
• BPD In Women: Know The Signs
• Bipolar Disorder In Women: Prevalence, Symptoms, And Treatment

Sources

1. Hyde, Janet S. PhD; Mezulis, Amy H. PhD. Gender Differences in Depression: Biological, Affective, Cognitive, and Sociocultural Factors. Harvard Review of Psychiatry 28(1):p 4-13, 1/2 2020. Link. Accessed September 16, 2024.
2. Albert, P. R. Why is depression more prevalent in women? Journal of Psychiatry & Neuroscience.. 2015;40(4), 219-221. Link. Accessed September 16, 2024.
3. Farhane-Medina, N. Z., Luque, B., Tabernero, C., & Castillo-Mayén, R. Factors associated with gender and sex differences in anxiety prevalence and comorbidity: A systematic review. Science Progress. 2022. Link. Accessed September 16, 2024.
4. Javaid, S.F., Hashim, I.J., Hashim, M.J. et al. Epidemiology of anxiety disorders: global burden and sociodemographic associations. Middle East Curr Psychiatry 2023;30, 44. Link. Accessed September 16, 2024.
5. Hiscox, L.V., Sharp, T., Olff, M. et al. Sex-Based Contributors to and Consequences of Post-traumatic Stress Disorder. Curr Psychiatry Rep 25. 2023; 233–245. Link. Accessed September 16, 2024.
6. Tiyatiye, B., & Akosile, W. (2022). A systematic review of prevalence of comorbid obsessive-compulsive disorders and substance use disorders in clinical settings, 1990-2021. Journal of Substance Use. 2022;29(2), 180–185. Link. Accessed September 16, 2024.
7. Dr. Noreena Kausar, Amna Ishaq, & Dr. Muneeb Ahmed Toor. (2023). Prevalence of Obsessive-Compulsive Disorder in Psychiatric Patients. PAKISTAN JOURNAL OF LAW, ANALYSIS AND WISDOM, 2023;2(02), 1032–1041. Link. Accessed September 16, 2024.
8. Hinshaw SP, Nguyen PT, O’Grady SM, Rosenthal EA. Annual Research Review: Attention-deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions. J Child Psychol Psychiatry. 2022;Apr;63(4):484-496. Link. Accessed September 16, 2024.
9. Miola, A., Fountoulakis, K. N., Baldessarini, R. J., Veldic, M., Solmi, M., Rasgon, N., Ozerdem, A., Perugi, G., Frye, M. A., & Preti, A. (2023). Prevalence and outcomes of rapid cycling bipolar disorder: Mixed method systematic meta-review. Journal of Psychiatric Research. 2023;164, 404-415. Link. Accessed September 16, 2024.
10. Bozzatello, P., Blua, C., Brandellero, D., Baldassarri, L., Brasso, C., Rocca, P., & Bellino, S. Gender differences in borderline personality disorder: A narrative review. Frontiers in Psychiatry. 2024;15, 1320546. Link. Accessed September 16, 2024.

Garb, H. N. Race bias and gender bias in the diagnosis of psychological disorders. Clinical Psychology Review. 2021;90, 102087. Link. Accessed September 16, 2024.

Do You or a Loved One Have Symptoms of Depression and/or Psychosis?

If you or a loved one are experiencing symptoms of depression or psychosis, seek help from a mental health professional. At Madison Ave TMS & Psychiatry, we can help you get the care you need. Contact us online or call (212) 731-2033 to make an appointment with a licensed healthcare professional today.

Resources:

1. Major Depression. National Institute of Mental Health. Publication Date Unknown. Updated January 2022. Link.

2. Psychotic depression. NHS. Updated Dec 10, 2019. Link. Accessed June 6, 2022.

3. Dubovsky, S. L., Ghosh, B. M., Serotte, J. C., & Cranwell, V. (2021). Psychotic Depression: Diagnosis, Differential Diagnosis, and Treatment. Psychotherapy and psychosomatics, 90(3), 160–177. Link. Accessed June 6, 2022.

​​4. Depression (major depressive disorder). Mayoclinic. Updated February 3, 2018. Link. Accessed June 6, 2022.

5. Major Depression with Psychotic Features (Psychotic Depression). Healthline. Updated January 13, 2016. Link. Accessed June 6, 2022. 

6. Carlson GA. Affective disorders and psychosis in youth. Child Adolesc Psychiatr Clin N Am. 2013 Oct;22(4):569–80. Link. Accessed June 6, 2022.

7. Rothschild AJ. Challenges in the treatment of major depressive disorder with psychotic features. Schizophr Bull. 2013 Jul;39(4):787–96. Link. Accessed June 6, 2022.

8. Gaudiano BA, Zimmerman M. The relationship between childhood trauma history and the psychotic subtype of major depression. Acta Psychiatr Scand. 2010 Jun;121(6):462–70. Link. Accessed June 6, 2022.

9. Rückl S, Gentner NC, Büche L, Backenstrass M, Barthel A, Vedder H, et al. Coping with delusions in schizophrenia and affective disorder with psychotic symptoms: the relationship between coping strategies and dimensions of delusion. Psychopathology. 2015;48(1):11–7. Link. Accessed June 6, 2022.

10. What is Electroconvulsive Therapy (ECT)? American Psychiatric Association. Published July 2019. Link. Accessed June 6, 2022.

11. Cole JC, Green Bernacki C, Helmer A, Pinninti N, O’reardon JP. Efficacy of Transcranial Magnetic Stimulation (TMS) in the Treatment of Schizophrenia: A Review of the Literature to Date. Innov Clin Neurosci. 2015;12(7-8):12-19. Link. Accessed June 12, 2022.

Dr. David Woo

Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.