Post-psychotic Depression: A Critical Review

Objective: To review the literature surrounding post-psychotic depression including its prevalence, potential pathways to its emergence and deficiencies in the current understanding. Method: Electronic literature search of PubMed, PsychINFO and Web of Knowledge using search terms relating to post-psychotic depression. Results: Prevalence rates have been clouded by heterogeneous samples. Three ontological theories were present in the literature. Evidence supported a range of pathways including post-psychotic depression as intrinsic to psychosis, as resulting from neuroleptic medication or as an emotional reaction to psychosis. Further research with homogeneous samples and precise definitions of post-psychotic depression are needed to confirm these findings. Methodological problems, inconsistencies in definition and implications for the International Statistical Classification of Diseases and Related Health Problems 10th Edition (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) classification are discussed. Conclusion: Better understanding of the origins and course of post-psychotic depression is required to guide future research and treatment approaches. Clearer definition and samples are crucial in this endeavour. Review of the literature public policy relevance statement: Despite it prevalence the recognition of post-psychotic depression has been varied at best. The validation of promising theoretical models has not been undertaken resulting in a delay in the development of much-needed treatments. This review argues that psychological mechanisms are central to overcoming both these issues, and also improve understanding of this highly disabling problem in post-psychosis adjustment which has significant implications for poor recovery and suicide risk.