MindMap

Understanding Depression and Suicide in Early Psychosis: What You Need to Know

Posted on by Glen
image of mother comforting sad daughter with text "depression and suicide in relationship to psychosis"

Experiencing a first episode of psychosis (FEP) an be overwhelming and frightening. However, what many don’t realize is that depression often accompanies early psychosis. In fact, individuals with FEP frequently grapple with deep sadness, hopelessness, and even suicidal thoughts. Therefore, depression in FEP isn’t just a secondary issue—it’s a serious and life-threatening concern that demands immediate attention. 

Depression in First-Episode Psychosis: A Silent Struggle

Depression goes far beyond just feeling sad. For instance, those with early psychosis can feel like a dark cloud that overshadows every aspect of life. As a result, people may lose interest in activities they once enjoyed, feel constantly fatigued, and struggle with low self-esteem. In some cases, the weight of depression can lead to suicidal thoughts, making this condition particularly dangerous.

depression and psychosis blurry image of boy with hands on his head

Why Depression in FEP Matters: Alarming Statistics

Research shows that up to 70% of individuals with first-episode psychosis also experience depression (1). This combination of psychosis and depression is not only challenging but can also be life-threatening. Moreover, suicide is the leading cause of death within the first five years after a psychosis diagnosis, with the risk of suicide being 60% higher during the first year of treatment than at later stages (2,3).

Yale University’s Specialized Treatment Early in Psychosis (STEP) program found that depression is the strongest predictor of suicidal tendencies at both 6 and 12 months after diagnosis (4). Therefore, this highlights the urgent need for early intervention, especially during the initial stages of psychosis.

How to Recognize Depression in FEP

Identifying depression in someone experiencing psychosis is critical for early intervention. To help with this, look for the following signs: 

  • Persistent Sadness

    The person may seem tearful or down most of the time.

  • Loss of Interest

    They may lose interest in social activities, hobbies, or things they previously enjoyed.

  • Fatigue

    Constant tiredness, even after sufficient rest, is common.

  • Changes in Appetite or Sleep

    Look for significant weight changes or shifts in sleep patterns.

  • Feelings of Hopelessness

    Expressions of guilt, worthlessness, or hopelessness, and a lack of future plans are common indicators.

  • Suicidal Thoughts

    Any mention or hint of suicidal thoughts must be taken seriously.

  • Substance Abuse

    An increase in alcohol, cannabis, or opioid use may indicate they’re trying to cope with overwhelming feelings.

What Can Be Done? Treatment is available and it works!

If you notice these signs, it’s crucial to seek help from a mental health professional. Fortunately, treatments like cognitive-behavioral therapy (CBT), along with antipsychotic or antidepressant medications, have been shown to significantly reduce symptoms and improve outcomes (5,6). In addition, support from family and friends also plays a key role in helping individuals cope with FEP and depression. 

mother comforting depressed and upset daughter

How to Support Someone with Depression in FEP

1. Listen Without Judgment

First, offering a listening ear is a powerful way to support someone with depression. For example, people with FEP may feel overwhelmed, scared, or confused. By allowing them to express their feelings without judgment or pressure, you create a safe space for them to share. 

2. Encourage Professional Help

In many cases, depression in FEP typically requires professional intervention. Therefore, you’ll want to encourage them to seek help from a therapist, counselor, or psychiatrist. You might even offer to assist in researching options or accompany them to appointments.

3. Create Safe, Calm Environment

A stable, quiet environment can help reduce stress and paranoia in someone experiencing psychosis. Moreover, encourage routines and minimize overstimulation like loud noises or chaotic settings. Offer reassurance if they feel anxious or distressed.  

4. Offer Practical Help

Depression can make even basic tasks seem daunting. Because of this, offering to help with cooking, cleaning, or scheduling appointments can ease their burden. Little things can go a long way in making daily life easier for them. 

5. Be Patient and Empathetic

Recovery is often a long process with many ups and downs. As such, offering ongoing empathy and patience is crucial. Let them know you are there to support them along the way.  

6. Encourage Self-Care

Small self-care actions can help improve mood and overall well-being. Encourage them to engage in activities they enjoy, like walking, listening to music, or spending time outdoors. Self-care routines can help them feel more in control.  

7. Watch for Warning Signs

As discussed, depression in FEP can lead to thoughts of self-harm or suicide. Be vigilant about signs of suicidal thoughts or actions. Sudden withdrawal, talk of hopelessness, or changes in mood should prompt immediate concern. If an emergency arises, do not hesitate to contact 911 or 988 (the suicide and crisis hotline). 

8. Educate Yourself on First-Episode Psychosis

Finally, understanding the symptoms and challenges of FEP will enable you to provide better support.  Start by learning about psychosis, the treatment process, and the role depression plays in these experiences. You can start by exploring our resources. 

The Takeaway

In conclusion, depression in early psychosis is a critical issue, with a heightened risk of suicide, particularly during the first few years after diagnosis. Thus, early detection and treatment can prevent tragedy and improve long-term outcomes. If you or someone you know is struggling, don’t hesitate—reach out for help today. 

For more information, you can follow the Provider Trainings and Family & Community Workshops hosted by the STEP Learning Collaborative, where experts discuss psychosis and offer support strategies both providers and families.


Author: Sumeyra Tayfur, PhD 

References

  1. Bashir, Z., Griffiths, S. L., & Upthegrove, R. (2022). Recognition and management of depression in early psychosis. BJPsych Bulletin, 46(2), 83-89. 
  2. Bornheimer, L. A. (2019). Suicidal ideation in first‐episode psychosis (FEP): Examination of symptoms of depression and psychosis among individuals in an early phase of treatment. Suicide and Life‐Threatening Behavior, 49(2), 423-431. 
  3. Kurdyak, P., Mallia, E., De Oliveira, C., Carvalho, A. F., Kozloff, N., Zaheer, J., … & Voineskos, A. N. (2021). Mortality after the first diagnosis of schizophrenia-spectrum disorders: a population-based retrospective cohort study. Schizophrenia bulletin, 47(3), 864-874. 
  4. Tayfur, S.N., Song, Z., Li, F., Hazan, H., Gibbs-Dean, T., Purushothaman, D., Karmani, S., Ponce Terashima, J., Tek, C. and Srihari, V. (2024). Insight and Suicidality in First Episode Psychosis: The Mediating Role of Depression. medRxiv, 2024-07. 
  5. Pelizza, L., Quattrone, E., Leuci, E., Paulillo, G., Azzali, S., Pupo, S., & Pellegrini, P. (2022). Anxious-depressive symptoms after a first episode of schizophrenia: response to treatment and psychopathological considerations from the 2-year “Parma Early Psychosis” program. Psychiatry research, 317, 114887. 
  6. Meltzer, H. Y., Alphs, L., Green, A. I., Altamura, A. C., Anand, R., Bertoldi, A., … & InterSePT Study Group. (2003). Clozapine treatment for suicidality in schizophrenia: international suicide prevention trial (InterSePT). Archives of general psychiatry, 60(1), 82-91.