According to the National Institute of Mental Health, schizophrenia is a mental disorder that involves psychosis, which means a person may be disconnected from reality. While schizophrenia is often linked to symptoms like hallucinations and delusions, some of its symptoms can look like depression, making it hard to tell the two apart.

It can be tough to know the difference between schizophrenic symptoms and major depressive disorder (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.

Schizophrenic symptoms are usually grouped into three categories, according to the American Psychiatric Association:

• Cognitive symptoms — Problems with attention, concentration, and memory
• Negative symptoms —These are often confused with depression and include low mood and lack of motivation
• Positive symptoms — These are also called “psychotic symptoms” and involve changes in how a person sees reality, such as hallucinations, delusions, and disorganized thinking

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.

1. Both Can Lower Mood, Pleasure, and Motivation

A low mood is one of the negative symptoms of schizophrenia. Healthcare professionals say these negative symptoms often have a greater impact on daily life for people with schizophrenia than the positive symptoms.

Both schizophrenia and depression can cause low mood, loss of interest in activities you used to enjoy, lack of motivation, and the inability to feel pleasure.

Many negative symptoms of schizophrenia overlap with depression. Both conditions can cause:

• A sad or low mood
• Loss of interest in activities you used to enjoy
• Lack of motivation
• Anhedonia (inability to feel pleasure)

Anhedonia is when you no longer feel pleasure from activities you used to enjoy. It might feel like emptiness, numbness, boredom, or negativity. If you’re experiencing anhedonia, you might find it harder to sleep well or stick to your regular routines. You may also notice a lower sex drive.

Pleasure and motivation are related, but anhedonia and apathy (lack of motivation) are not the same. Apathy means you don’t have the motivation or energy to do tasks, while anhedonia means you don’t feel rewarded for doing things.

2. Both Conditions Increase the Risk of Suicide

Suicidal thoughts aren’t usually seen as a symptom of schizophrenia, but they are more common in people with schizophrenia than in the general population. These thoughts can happen with or without depression.

A 2021 cohort study found that the risk of suicide is 4.5 times higher in those with schizophrenia than in the general population. Factors that may increase suicide risk in people with schizophrenia include:

• A history of substance abuse
• Being young
• Being male
• Having severe symptoms like delusions and hallucinations

• Having a higher education

A 2021 research review published in Frontiers in Psychiatry found that people diagnosed with MDD are five times more likely to attempt suicide than those without depression.

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

3. Social Withdrawal Is Common With Schizophrenia and Depression

Both schizophrenia and depression can lead to social isolation. One type of anhedonia, social anhedonia, means you no longer feel pleasure from being around others. This can make people less likely to seek out social interactions.

Social dysfunction can be an early sign of mental health conditions including schizophrenia and MDD. Along with psychiatric medication, psychosocial treatment like individual or group therapy can help people with schizophrenia or MDD who struggle with social withdrawal.

Differences Between Schizophrenia and Depression

There are several key differences between these two conditions.

1. Schizophrenia Causes Hallucinations, Delusions, and Disorganized Speech

The main difference between depression and schizophrenia is that schizophrenia causes hallucinations, delusions, and disorganized speech. These symptoms happen without the high-energy mood swings (mania) or severe low moods (depressive episodes) seen in other conditions. If mood problems do happen during a schizophrenic episode, they usually don’t last long.

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

A hallucination is when someone hears, sees, smells, or feels something that isn’t really there. Hallucinations are a positive symptom of schizophrenia that can also happen in people with severe depression. Types of hallucinations include:

• Auditory hallucinations (most common) — Hearing voices or other sounds
• Visual hallucinations — Seeing people, objects, or lights that aren’t there
• Olfactory hallucinations — Smelling things (good or bad) with no source
• Tactile hallucinations — Feeling things like crawling on or under the skin

Delusions are a common psychotic symptom of schizophrenia that fall under the category of positive symptoms. Delusions are strong beliefs that don’t match reality.

Types of delusions 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

2. First-Line Medications Differ

It’s difficult to treat schizophrenia without medication. Antipsychotic medications are the first line of treatment for schizophrenia. Research shows that starting antipsychotics as soon as possible after the first psychotic episode is important because most brain changes happen in the first five years after the initial episode.

The most commonly used antipsychotics are second-generation antipsychotics (also called atypical antipsychotics). Older, first-generation antipsychotics are still used but tend to have more side effects. Your doctor may also prescribe antidepressants, mood stabilizers, or antianxiety medications along with antipsychotics.

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

Both schizophrenia and depression treatment plans often include psychotherapy (talk therapy).

3. Thought Disorder Is Much Less Common in Depression

Thought disorder is a key feature of schizophrenia but rarely happens in depression. It affects how a person speaks and thinks. Signs of thought disorder 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

Antipsychotic medications can help reduce thought disorder symptoms during psychotic episodes. However, these symptoms may continue even after the person with schizophrenia is in remission. This can be a sign of a worse prognosis, or outlook, in the long run.

Thought disorder is a feature of schizophrenia that can make it hard to succeed at work or in social situations.

Can Someone Have Both Schizophrenia and Depression?

Sometimes schizophrenia can be misdiagnosed as depression. A person might first be diagnosed with MDD, and later, a doctor might realize it’s schizophrenia. Someone with depression might even be prescribed antipsychotics.

It’s possible to have major depression with psychotic features, which can make the diagnosis challenging.

These conditions can overlap because they share some risk factors, including stress and trauma. Schizophrenic spectrum disorders and mood disorders also have similar symptoms, and some people with depression can have psychotic features. This can make it hard to tell them apart.

Researchers are studying ways to use brain scans (like functional MRI) to help diagnose schizophrenia versus mood disorders. In the future, these tests might be used more often to make accurate diagnoses.

Can Depression Cause Schizophrenia?

No, depression doesn’t cause schizophrenia. They are separate conditions that work differently. However, having depression doesn’t mean you can’t have schizophrenia later. Some people may have both conditions at the same time — a situation known as comorbidity, which requires careful diagnosis and treatment by mental health professionals.

A trained mental health professional can tell the difference between depression, schizophrenia, and psychotic depression. They can also identify when both conditions are happening together.

Only a psychiatrist, clinical psychologist, or other qualified mental health professional can officially diagnose schizophrenia or other mental disorders. However, understanding your symptoms — or those of a loved one — can help your doctor find the best treatment options and improve your quality of life. If you or a loved one is experiencing any of the symptoms described here, talk to your doctor.

Talk With Others Who Understand

MyDepressionTeam is the social network for people with depression and their loved ones. On MyDepressionTeam, more than 150,000 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 having 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.