Psychotic depression has been distinguished from nonpsychotic depression by its association with poorer premorbid function, longer depressive episodes, less responsive to antidepressants, and worse prognosis. Empirical evidences also suggest that compared with nonpsychotic depression, psychotic depression is associated with a higher rate of neurobiological alteration, such as structural brain abnormalities and excessive hypothalamic pituitary adrenal axis activity. Also, it is associated with more cognitive deficits.