Psychotic Depression: Symptoms and Specialized Treatment in Madrid

There are ways to depression that go beyond just feeling down. When the depression When false and unshakable beliefs (delusions) or perceptions that do not exist in reality (hallucinations) are added to a serious condition, one may find a psychotic depression. It is less common but more severe, and requires a specialized approach that combines psychotherapy and psychiatry. The good news is that up to 95% of patients respond positively to treatment. At MadridPsicoterapia, with a practice in Chamberí, we work closely with psychiatrists to offer comprehensive and safe treatment.

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Depression psychotic

What is psychotic depression, and how is it identified?

The psychotic depression, is a depressive episode a severe condition in which, in addition to the symptoms typical of the major depression, psychotic symptoms appear: delusions, hallucinations, or depressive stupor. Psychotic symptoms include delusions, ideas of reference, hallucinations, and depressive stupor of such intensity that they prevent normal social activities and may pose a life-threatening risk due to suicide or neglect of self-care (dehydration, malnutrition).

Delusions in the psychotic depression are consistent with the depressive state: they are typically delusions of guilt (believing one has committed a terrible sin or crime), of ruin (the conviction that one has ruined the family), of illness (the certainty of suffering from a serious and incurable disease), or nihilistic (the belief that one’s self or the world has ceased to exist). Hallucinations, which are generally auditory, also have depressive content: voices that insult, accuse, or incite suicide.

Unlike schizophrenia, in the psychotic depression Psychotic symptoms are closely linked to the depressive episode and tend to subside as the condition improves. The diagnostic distinction is essential because the treatment differs.

The treatment of depression Psychotic treatment combines antidepressants and antipsychotics, a combination that has been shown to be more effective than either drug alone. Psychotherapy plays a complementary role, especially during the maintenance phase.

At MadridPsicoterapia (141 Santa Engracia Street, Chamberí, Madrid), we work in close coordination with psychiatrists to ensure the safety and effectiveness of treatment.

Symptoms

Types

Treatment

When to Ask for Help

Depression in Adolescents

Depression Test

You know exactly what you're paying from day one

How much do the sessions cost?

€ 55

Price per session

Comprehensive Evaluation
Weekly sessions*
Online and In-Person Services **

€220

€ 199

Monthly

Comprehensive Evaluation
Weekly sessions*
20% discount**

Popular

Why Choose Us

Why Choose MadridPsicoterapia?

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Licensed and Specialized Psychologists

Our Team consists of licensed health psychologists at the COP in Madrid, with specialized training and proven experience in treating depressive disorders. We work with professional rigor and stay up to date with the latest scientific developments to provide you with the best possible care.

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Evidence-Based Therapies

We use a variety of approaches, such as cognitive-behavioral therapy, ACT, exposure and emotional regulation techniques, and third-generation therapies, among others, because we believe you deserve treatment for depression that has proven its effectiveness in rigorous clinical research—not fads or empty promises.

✓

Personalized Treatment Plan

We don't follow rigid protocols. After a detailed initial evaluation, we design a treatment plan tailored to your specific situation, your goals, and your schedule. Because we understand that everyone experiences the depression in a unique way, and the approach must respect that uniqueness

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Central location in Chamberí

Our office is located at 141 Santa Engracia Street, in the Chamberí neighborhood, with excellent Metro and bus connections. We also offer treatment for depression in Chamberí, both in person and online for those who prefer the convenience of joining from home.

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Compassionate and non-judgmental support

We know that taking the step to ask for help isn’t always easy. That’s why at MadridPsicoterapia you’ll find a warm, confidential, and judgment-free space where you are our top priority. We’re committed to supporting you with honesty, empathy, and absolute respect for your journey.

Prices with no surprises and no pressure

Making decisions is also part of the process.

We offer you an initial session—either online or in person—so we can get to know each other.

From there, you should only continue if you feel you've established a connection with the professional you've met. The rest of the process is flexible, tWe explain how it works and the terms and conditions starting with the first session. No monthly fees, no long-term commitments, and fixed prices per session.

Individual Therapy

55 €

Couples Therapy

65 €

Individual Therapy

55 €

Therapy for couples

65 €

It's not how many, it's how

People who started individual therapy with us in Madrid

Juana, Carlos, Rocío, Almudena… We don't like to talk about numbers. We help real people with real names in real-life situations. It could be your neighbor, a friend, a mother, a coworker, your child… every name holds a different story. And every story deserves to be truly heard.

I came because my wife asked me to. I thought there was nothing wrong with me, but I was impossible to be around. Here, I've been able to talk about things I'd never talked about with anyone before. I've come to understand where all that anger was coming from. Things at home have improved a lot.

I started this after my partner suddenly broke up with me. The first few months were awful. Here, I've been able to let go of all that pain without feeling like I was burdening anyone. I've also worked on patterns I kept repeating in my relationships. It's helped me a lot.

I lost my mother years ago, and I was still having a really hard time. Here, I've learned that grief takes its own time. I still miss her every day, but it's different now.

I was on sick leave due to stress, headaches, insomnia, digestive problems… The usual stuff. Here, I’ve been working on setting boundaries at work. It’s not like I’m a completely different person now, but at least I’ve learned to say no every once in a while. To be honest, it’s still incredibly hard for me.

My kids and I were in a terrible place after the divorce. All we did was argue. I've worked on improving our communication, and well, now at least we can talk without ending up yelling at each other.

I started online therapy because my work schedule made it impossible to attend in-person sessions. At first, I thought it wouldn't be the same, but it's worked out really well for me—I do it from home after I get back from work, when everyone else is asleep.

My job requires me to travel constantly, and online therapy has been the only way I've been able to stay in therapy. It doesn't matter if I'm in Madrid, Barcelona, or anywhere else. I just log in, and that's it.

I felt trapped in a life that wasn't my own. I was doing what was expected of me, not what I wanted to do. I've been working on connecting with what I truly want. I'm making some major changes.

After becoming a mother, I felt invisible. I was just “the mother of.” I’ve worked on my identity beyond motherhood and have reclaimed parts of myself that I had lost.

I live in a small town where everyone knows each other. Online therapy has allowed me to find a professional outside of town without anyone seeing me go in or out of anywhere. I've worked through some very personal issues that I would never have talked about here. I highly recommend it.

I started online during the lockdown and just stuck with it. I like being able to do it from home, without wasting time commuting. I've been working on my social anxiety, and starting online actually took that pressure off me.

Online therapy seemed a little strange to me at first, but with my shift work, it was impossible to fit in in-person appointments. Being able to log in at 10 p.m. after work has been key. If it had been in person, I would have quit right away.

I used to have uncontrollable outbursts of anger. I'd fly off the handle over the slightest thing and say terrible things. I'd lost friends because of this. I've worked on identifying what triggers me. My relationships have improved a lot.

I tried online therapy because I was too embarrassed to go to an in-person session. I know it sounds silly, but that's just how it is. From my room, where no one can see me, I've found it easier to open up. So far, this is working for me, and I feel comfortable this way.

I've been doing online therapy ever since I moved abroad. I wanted to continue seeing my longtime therapist, and this has made that possible. We've been doing this for two years now. The screen can sometimes be a barrier, but being able to maintain that therapeutic connection despite the distance is priceless.

I have two young children, and getting out of the house is a nightmare. Online therapy has been a lifesaver. While they’re napping, I log on. No commuting, no having to find someone to watch the kids. It’s been the only way I’ve been able to take care of myself, too.

My father has Alzheimer's, and I take care of everything. I was completely overwhelmed, juggling my own life and taking care of him. Here, I've been able to let off some steam without feeling guilty for being tired. I've learned to ask for help. It was either that or end up completely worn out myself.

My partner and I hadn't had sex in over a year. We were too embarrassed to even talk about it. Working on this here has helped us communicate better in general. We've regained that connection.

Online therapy made me a little nervous at first. I thought it would be weird to talk about my personal stuff in front of a screen. But it’s actually even more comfortable. I’m in my safe space, on my couch, with my blanket.

After I was dumped, I felt terrible. A friend recommended that I come here. It helped me a lot during the first few months—I could cry and let it all out. Then I stopped coming because I was feeling better. A few months later, I started feeling bad again, so I came back.

I was diagnosed with a chronic illness and it really got me down. I've been in therapy for six months. Some days I leave the session thinking, "That was great—really helpful." Other days I leave thinking, "Why am I even coming here if this isn't going to cure me?" But I'm grateful to the team.

We went to couples therapy. After four months, we broke up anyway. I don't know if it helped at all or if it just delayed the inevitable. But hey, at least we broke up without killing each other—that's something, at least.

Total apathy. A friend told me to come. I've been coming for three months. I don't know if I've noticed any changes. I still wake up without any motivation. But hey, at least for one hour a week I'm doing something other than lying on the couch. My psychologist says that just coming here is already a step forward.

Some very dark thoughts brought me here two years ago. I've improved a lot—I won't deny it. My psychologist explained to me that it's not like that, that there can be relapses. It bothered me to hear that, to be honest. But anyway, I'm still working on it.

I've been dealing with depression for two years. I've tried medication, gone to therapy, exercised—I've tried everything. There are times when I feel better, and other times when I slip back into it. I'm grateful that I've been able to stick it out, and I recommend reaching out for help.

I worry about everything: work, anxiety—which causes me horrible physical symptoms. Dizziness, rapid heartbeat, sweating. I’ve gone to the emergency room about five times thinking I was dying. It’s always anxiety. I’m doing online therapy because I’m terrified of leaving the house.

I've tried everything—yoga, meditation, pills. Nothing works for me. I've been doing online therapy for six months now. The other day, I had a panic attack during the session. I felt ridiculous. My therapist told me it was okay, that it was a good time to work through it.

I have a really hard time socializing with people. Just the thought of meeting up with friends makes me anxious days in advance. I started therapy a year ago. I've improved in some ways: I can go shopping without feeling so bad, and I can talk on the phone.

My anxiety started a couple of years ago. At first, I thought it was just work-related stress. I started online therapy because, with my schedule, it's impossible to go to in-person sessions. Sometimes it helps me to log in from home; other times, having the computer in front of me distracts me.

I felt constantly overwhelmed by work, by life, by everything. I couldn't stop mulling things over. A friend recommended online therapy to me. At first I was skeptical; I thought talking through a screen wouldn't do any good.

I have pretty severe social anxiety. Online therapy was perfect for me because being able to start without having to physically go anywhere took a lot of the pressure off. I've improved quite a bit in some areas—thank you!

I was diagnosed with depression a year ago. The first thing I thought was, “But I’m not sad all the time.” I started online therapy because I didn’t even have the energy to leave the house. It’s been seven months, and I’m starting to notice some changes.

Depression caught me by surprise. I had always been an active, energetic person. Suddenly, I found myself not wanting to do any of the things I used to enjoy. Going to the gym, hanging out with friends—everything felt like too much trouble. I felt empty.

I started online therapy six months ago because, honestly, I didn't have the energy to leave the house. Progress has been slow. Some weeks I feel a little better; other weeks I'm back to square one. But I'm learning that depression isn't something you can just snap out of.

I've been dealing with depression for about two years. The hardest part is that it's invisible—people look at me and think I'm fine. But inside, I feel empty most of the time. Getting through the day feels like climbing a mountain. I started online.

Frequently Asked Questions

Frequently Asked Questions About Psychotic Depression

We know that many questions may arise before starting therapy. Here, we answer the most common questions we receive from people who contact our clinic.

What is the difference between psychotic depression and schizophrenia?

Although both conditions involve psychotic symptoms, their origin and course differ. In psychotic depression, delusions and hallucinations are directly linked to the depressive episode: their content is consistent with depression (guilt, ruin, illness) and they tend to disappear as the depressive episode improves. In schizophrenia, psychotic symptoms are the core of the disorder; they have more bizarre and implausible content, and they persist even outside of mood episodes. The differential diagnosis requires a comprehensive psychiatric evaluation that includes a detailed medical history and, if necessary, additional tests.

Can psychotic depression be treated with psychotherapy alone?

No. Psychotic depression is one of the conditions in which medication is essential. The combination of antidepressants and antipsychotics has proven to be significantly more effective than any monotherapy. Psychotherapy plays an important but complementary role: it helps during the stabilization and maintenance phases, aids in understanding the patient’s lived experience, and helps prevent relapses. It is not appropriate to begin intensive psychotherapy during the acute phase of a psychotic episode; rather, it should begin once medication has achieved a minimum level of stabilization.

What are the warning signs that depression is turning into psychosis?

Warning signs that may indicate a depressive episode is progressing toward a psychotic state include: the emergence of strange beliefs that the person holds with conviction despite contrary evidence (delusions), hearing voices that do not exist or seeing things that others do not see (hallucinations), a progressive detachment from reality, extreme agitation or immobility (stupor), a total refusal to eat or drink, and imminent suicide risk. If any of these signs are present, an urgent psychiatric evaluation is necessary. Call 919 932 920 or go to a hospital’s emergency room.

Can psychotic depression recur?

Yes. Like other types of severe depression, psychotic depression carries a high risk of recurrence. People who have experienced an episode are more likely to have another one, especially if they stop maintenance treatment prematurely. That’s why, after a psychotic episode, it’s essential to continue psychiatric and psychological follow-up for at least one to two years and to learn how to recognize the early signs of a possible relapse so you can act quickly.

Can a family member with psychotic depression be dangerous?

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