Schizophrenia is a complex mental health condition that can change the way someone experiences emotions, thoughts, and daily life. Depression, or major depressive disorder (MDD), is a mood condition marked by ongoing sadness and reduced interest or pleasure in activities.

While schizophrenia is often linked to hallucinations and delusions, some symptoms can look like depression. It can be hard to tell the difference between schizophrenia symptoms and MDD if you’re not sure what to look for.

If you notice symptoms in yourself, a family member, or a friend, the first step is to talk to a mental health professional. They can provide a proper diagnosis and help you get the right care and treatment.

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Schizophrenia symptoms are usually grouped into three categories:

• Cognitive symptoms — Problems with attention, concentration, and memory
• Negative symptoms — Loss of motivation, loss of interest or enjoyment, social withdrawal, reduced emotional expression, and difficulty functioning normally
• Positive symptoms — Also called psychotic symptoms, these include hallucinations, delusions, and disorganized thinking

The difference between positive and negative symptoms of schizophrenia is that positive symptoms add experiences that usually aren’t there, while negative symptoms involve a loss or decrease in typical emotions, motivation, or social behavior.

Let’s look at the main similarities and differences between schizophrenia and depression to help you be more informed when talking to your doctor.

Similarities Between Schizophrenia and Depression

There are a few ways schizophrenia and depression are alike.

Similarity 1

Both Can Affect Pleasure, Motivation, and Mood

Depressed mood is more characteristic of depression than schizophrenia, but the two conditions can still overlap. The overlap is often strongest around anhedonia, low motivation, and social withdrawal, symptoms that may be present in both conditions.

Anhedonia means you no longer feel pleasure from activities you used to enjoy. It may feel like numbness, boredom, or apathy.

Similarity 2

Both Conditions Can Cause Psychotic Features

Psychotic symptoms can also happen in severe depression. In psychotic depression, also called major depression with psychotic features, hallucinations or delusions happen along with severe depression.

That timing matters. People with major depression with psychotic features experience psychosis only during mood episodes, while in schizophrenia, psychosis occurs for most of the time that the person has been ill.

Schizoaffective disorder, a condition closely related to schizophrenia, requires at least two weeks of psychotic symptoms without mood symptoms.

Similarity 3

Both Conditions Increase the Risk of Suicide

Suicidal thoughts aren’t usually listed as a core diagnostic symptom of schizophrenia, but people with schizophrenia do have a higher risk of suicide than the general population. About 4.9 percent of people with schizophrenia die by suicide, with the highest risk early in the illness.

Depression also raises suicide risk. In a 2021 review, people with MDD had a higher risk of suicidality than people without MDD.

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

Similarity 4

Social Withdrawal Is Common With Schizophrenia and Depression

Both schizophrenia and depression can lead to social withdrawal. One type of anhedonia, social anhedonia, means you no longer enjoy being around people.

Social withdrawal can also happen during prodromal schizophrenia, which is an early phase that may happen before a first psychotic episode. Along with medication, psychosocial care may help people with schizophrenia manage symptoms, attend school or work, and build relationships.

Differences Between Schizophrenia and Depression

There are several key differences between these two conditions.

Difference 1

Schizophrenia Can Cause Hallucinations, Somatic Delusions, and Disorganized Speech Without a Mood Episode

One important difference is that schizophrenia can cause psychotic symptoms even when a person is not having a major mood episode. In major depression with psychotic features, hallucinations or delusions happen during a depressive episode. Psychotic symptoms may include hallucinations, delusions, and disorganized speech.

A hallucination is when someone hears, sees, smells, tastes, or feels something that isn’t there. Auditory hallucinations — hearing voices or other sounds — are the most common type in schizophrenia.

Other types include visual, olfactory, tactile, and somatic hallucinations. Tactile hallucinations involve feeling touch or other sensations on the skin when nothing is there. Somatic hallucinations involve unusual sensations that seem to come from inside the body.

Delusions are strong beliefs that don’t match reality. Somatic delusions are false beliefs that something is wrong with the body, such as having a medical problem that isn’t actually present.

Other delusion types can include:

• Persecutory delusions — Believing someone or a group is trying to harm you
• Grandiose delusions — Believing you have special powers or importance
• Somatic delusions — Believing something is wrong with your body
• Erotomanic delusions — Believing someone famous or powerful is in love with you

Difference 2

First-Line Medications Differ

Schizophrenia treatment usually includes antipsychotic medication. These medicines aim to make psychotic symptoms less intense and less frequent.

Starting treatment as soon as possible after a first episode of psychosis is important for recovery. Schizophrenia treatment often combines medication with psychosocial care, such as psychotherapy, behavioral skills training, supported employment, and family education.

For depression, treatment often includes antidepressants, psychotherapy, or both. Selective serotonin reuptake inhibitors are commonly used antidepressants.

Difference 3

Thought Disorder Is Much Less Common in Depression

Thought disorder is a key feature of schizophrenia. It affects how a person speaks and thinks.

Signs may include:

• Jumping between unrelated topics
• Giving answers that don’t make sense
• Saying things that sound like “word salad” (a mix of words that don’t go together)

Disorganized thinking and speech can make communication difficult. It may also affect work, school, and relationships. If thought disorder symptoms affect your ability to work, employment support may be part of a care plan.

Can Depression Cause Schizophrenia?

No, depression doesn’t cause schizophrenia. Depression, schizophrenia, psychotic depression, and schizoaffective disorder are separate diagnoses with different symptom patterns.

However, a person can have depression and later develop schizophrenia, or they may have both conditions at the same time.

A trained mental health professional can tell the difference between these conditions. A psychiatrist, clinical psychologist, or other qualified healthcare professional can diagnose conditions such as schizophrenia or depression.

Understanding your symptoms — or those of a loved one — can help your doctor find the best treatment options. If you or a loved one is experiencing any of the symptoms described here, talk to your doctor.