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Schizophrenia and Depression: 3 Similarities and 3 Differences

Medically reviewed by Andrew Turner, M.D.
Written by Brooke Dulka, Ph.D.
Updated on April 10, 2024

According to the National Institute of Mental Health, schizophrenia is a mental disorder of psychosis — that is, a condition characterized by a disconnection from reality. Schizophrenia is often associated with symptoms of hallucinations and delusions. Symptoms of the condition can sometimes overlap with those of depression.

Telling the difference between schizophrenic symptoms and symptoms of major depressive disorder (MDD) can be tough if you don’t know what to look for. If you recognize symptoms in a family member, friend, or yourself, a proper diagnosis from a mental health professional can serve as an essential first step toward receiving appropriate health care and treatment.

Schizophrenic symptoms can be divided into three categories:

  • Cognitive symptoms relate to attention, concentration, and memory.
  • Negative symptoms — which are often mistaken for depression — relate to decreases in mood and motivation.
  • Positive symptoms — also called “psychotic symptoms” — add something to a person’s perception of reality. These symptoms — which can include hallucinations, delusions, and thought disorder — can be difficult to recognize.

Learning about the main similarities and differences between schizophrenia and depression can help you to be more informed when you talk to your doctor.

Similarity 1: Both Disorders Cause Decreases in Mood, Pleasure, and Motivation

A low mood is one of the negative symptoms of schizophrenia. Health experts consider negative symptoms to have a greater impact on how people with schizophrenia function than positive symptoms do.

Negative symptoms aren’t limited to schizophrenia. Many of these symptoms, like low mood and loss of interest in things you usually enjoy, also overlap with mood disorders such as depression.

Both in mood disorders and schizophrenia, depression can cause lowered motivation. One symptom the conditions share is anhedonia, which is the inability to feel pleasure from things you usually enjoy. Anhedonia can feel like emptiness in situations where you would normally expect to have a more emotional reaction. This can come in the form of numbness, boredom, apathy, or negativity.

If you’re experiencing anhedonia, you might find it’s harder to get a good night’s sleep and stick to your regular routines. You may also have a lower sex drive.

Low mood and loss of interest in things you normally like can be symptoms of schizophrenia or depression.

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Pleasure and motivation are related, but anhedonia and apathy (lack of motivation) are not the same thing. Apathy is when you specifically do not have the motivation or energy to complete a task, while anhedonia means you do not feel rewarded for doing things.

Similarity 2: Both Conditions Increase the Risk of Suicide

Although suicidal thoughts aren’t typically thought of as a symptom of schizophrenia, they’re much more common in people with the condition than among the general population. These thoughts may occur with or without depression.

According to a 2010 review of 51 studies of people with schizophrenia, the lifetime rate of suicide in people with schizophrenia is around 5 percent. Researchers highlighted the following factors in the connection between schizophrenia and the risk of suicide:

  • Having a history of substance abuse
  • Being young
  • Being male
  • Having worse symptoms including delusions and hallucinations
  • Having a higher education

A research review from 2021 in Frontiers of Psychiatrey explained that people diagnosed with MDD also have five-times higher rate of suicide as compared to people without depression.

Note: If you or someone you know needs help, you can contact the 988 Suicide & Crisis Lifeline by calling or texting 988 or chatting online.

Similarity 3: Both Conditions Can Cause Social Withdrawal

The anhedonia caused by schizophrenia or depression can lead people to isolate themselves from others. One specific type of anhedonia, social anhedonia, means you don’t experience pleasure from being around other people anymore. This can make people less likely to seek out social interactions.

Social dysfunction can be the first sign of neuropsychiatric disorders including schizophrenia and major depressive disorder. Together with psychiatric medication, psychosocial treatment like individual or group therapy can be helpful for people with schizophrenia or MDD who experience social withdrawal.

Difference 1: Schizophrenia Causes Hallucinations, Delusions, and Disorganized Speech

The key difference between depression and schizophrenia is that schizophrenia causes delusions, hallucinations, and disorganized speech without simultaneous manic (high-energy or euphoric) episodes or depressive episodes. If a person does experience mood disorders during a schizophrenic episode, they’ll be present for only a small part of the total episode.

Feelings of mania or depression are not common during a schizophrenic episode.

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A hallucination is when a person hears, sees, smells, or feels something that isn’t actually there. Hallucinations are a positive symptom of schizophrenia that are sometimes seen in people with severe depression. Types of hallucinations include the following:

  • Auditory hallucinations are the most common type of hallucination. Typically, auditory hallucinations involve hearing voices telling the hallucinating person things to do. People may also hear other sounds, like whispering.
  • Visual hallucinations involve seeing people, objects, or lights that aren’t really there.
  • Olfactory hallucinations can involve smells that don’t relate to anything in the area. They can be hallucinations of pleasant or unpleasant smells.
  • With tactile hallucinations, a person might feel as if things are crawling across their skin or inside of them.

Delusions are a common psychotic symptom of schizophrenia that fall under the category of positive symptoms. Delusions are beliefs that conflict with reality.

Delusions tend to fall into one of several types, including the following:

  • Persecutory delusions — Beliefs that a person, a group of people, or an organization is out to get you
  • Grandiose delusions — Beliefs that involve an inflated sense of self-importance, such as believing one has special abilities or superpowers
  • Somatic delusions — Beliefs that something is wrong with one’s body
  • Erotomanic delusions — Delusions of love, a common one being the belief that someone in a position of power (such as a celebrity) is in love with you

Difference 2: First-Line Treatments for Schizophrenia Are Antipsychotics

It’s difficult to treat schizophrenia without using antipsychotic medications. Research suggests that antipsychotic treatment should be started as soon as possible after the first acute psychotic episode, because most illness-induced changes in the brain happen in the first five years after the initial episode.

The most commonly used antipsychotics are second-generation antipsychotics, also called atypical antipsychotics. Common examples of these medications are:

  • Aripiprazole (Abilify)
  • Asenapine (Saphris)
  • Clozapine (Clozaril or Versacloz)
  • Ziprasidone (Geodon)
  • Paliperidone (Invega)
  • Lurasidone (Latuda)
  • Risperidone (Risperdal)
  • Quetiapine (Seroquel)
  • Olanzapine (Zyprexa)
  • A combination of olanzapine and samidorphan (Lybalvi)

In contrast, first-line medications for depression are antidepressants, such as selective serotonin reuptake inhibitors (SSRIs).

Difference 3: Thought Disorder Is Far Less Common in Depression

Thought disorder refers to speech- and thought-related symptoms. Signs of impaired reasoning or talking may involve a person switching from topic to topic, giving answers that aren’t relevant to the question asked, or expressing what’s known as “word salad” — combinations of words that don’t linguistically make sense. Thought disorder has also been noted in cases of severe depression, though it’s not common.

Antipsychotic medications can help reduce thought disorder symptoms in acute psychotic episodes. However, these symptoms can sometimes continue even after the person with schizophrenia has entered clinical remission, which can signal a worse prognosis, or outlook, in the long run.

Thought disorder is a feature of schizophrenia sometimes associated with difficulty succeeding in the workplace and functioning socially.

Is It Possible To Have Both Schizophrenia and Depression?

Sometimes, people may be initially diagnosed with major depressive disorder only for a health care professional to later realize that it could be schizophrenia. Someone with depression may even be prescribed antipsychotics. These conditions overlap so readily, in part, because they share some risk factors, including stress and abuse.

Because schizophrenic spectrum disorders and mood disorders share many symptoms, and it’s possible to have depression with psychotic features, determining a correct diagnosis can be difficult. Therefore, understanding what distinguishes psychotic disorders from mood disorders can be helpful.


It’s possible to have major depression with psychotic features, which can make it difficult to determine a correct diagnosis.

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Researchers are testing ways to diagnose schizophrenia versus a mood disorder based on a functional MRI scan of the brain. Tests like this may one day be used more frequently in the clinic to make a diagnosis.

A trained professional can differentiate between depression and schizophrenia and between psychotic depression and schizophrenia. They can also tell when the conditions are occurring at the same time.

Only a psychiatrist, a clinical psychologist, or another qualified mental health professional can make an official diagnosis of schizophrenia or any other mental illness. However, understanding your symptoms — or those of your loved one — can help your doctor find the most appropriate treatment options and improve your quality of life. If you or a loved one is experiencing any of the symptoms described in this article, be sure to discuss them with your doctor.

Talk With Others Who Understand

MyDepressionTeam is the social network for people with depression and their loved ones. On MyDepressionTeam, more than 146,000 members come together to ask questions, give advice, and share their stories with others who understand life with mental health conditions like depression and schizophrenia.

Are you — or a loved one — experiencing symptoms of schizophrenia or mood disorders? Have you been diagnosed with schizophrenia or major depressive disorder? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Schizophrenia — Cleveland Clinic
  2. Mood Symptoms, Cognition, and Everyday Functioning — Innovations in Clinical Neuroscience
  3. Anhedonia — Cleveland Clinic
  4. Social Disconnection in Schizophrenia and the General Community — Schizophrenia Bulletin
  5. Social Brain, Social Dysfunction and Social Withdrawal — Neuroscience & Biobehavioral Reviews
  6. Depression and Suicide — Johns Hopkins Medicine
  7. Schizophrenia: Overview and Treatment Options — Pharmacy and Therapeutics
  8. Schizophrenia — National Institute of Mental Health
  9. Hallucinations in Schizophrenia — Acta Psychiatrica Scandinavica
  10. Hallucinations in Bipolar Disorder: Characteristics and Comparison to Unipolar Depression and Schizophrenia — Bipolar Disorders
  11. Schizophrenia: The Characteristic Symptoms — Schizophrenia Bulletin
  12. Thought Disorder in Depression — The American Journal of Psychiatry
  13. Suicide and Schizophrenia: A Systematic Review of Rates and Risk Factors — Journal of Psychopharmacology
  14. Prevalence of Suicidality in Major Depressive Disorder: A Systematic Review and Meta-Analysis of Comparative Studies — Frontiers in Psychiatry
  15. Negative Symptoms Have Greater Impact on Functioning Than Positive Symptoms in Schizophrenia: Analysis of CATIE Data — Schizophrenia Research
  16. Depression (Major Depressive Disorder) — Mayo Clinic
  17. Clinical Practice Guidelines for the Management of Depression — Indian Journal of Psychiatry
  18. Thought Disorder as a Neglected Dimension in Schizophrenia — Alpha Psychiatry
  19. Bipolar Disorder — Mayo Clinic
  20. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health: Table 3.22 DSM-IV to DSM-5 Schizophrenia Comparison — Substance Abuse and Mental Health Services Administration
  21. Antipsychotic Prescriptions Among Adults With Major Depressive Disorder in Office-Based Outpatient Settings: National Trends From 2006 to 2015 — The Journal of Clinical Psychiatry
  22. PW01-179 — The Stress-Vulnerability Model; How Does Stress Impact on Mental Illness at the Level of the Brain … and What Are the Consequences? — European Psychiatry
  23. Individualized Differential Diagnosis of Schizophrenia and Mood Disorders Using Neuroanatomical Biomarkers — Brain
  24. Psychotic Depression — NHS
    Updated on April 10, 2024
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    Andrew Turner, M.D. completed medical school at Creighton University School of Medicine. Learn more about him here.
    Brooke Dulka, Ph.D. is a freelance science writer and editor. She received her doctoral training in biological psychology at the University of Tennessee. Learn more about her here.

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