What Is Catatonic Depression?

Catatonic depression is when catatonia occurs concurrently with depression. Catatonia is a state in which a person experiences marked disturbances in motor activity. Although generally thought of as reduced engagement and activity, it may also manifest as excessive or peculiar motor symptoms.

Catatonia can be a part of another mental disorder or medical condition, or it may be categorized as "unspecified." Unspecified catatonia includes all cases in which there is no major psychotic, affective, or medical disorder that can be diagnosed.

Catatonia itself is not uncommon, affecting about 10% of people with psychiatric conditions in Western countries. People with symptoms of catatonia typically have a neurodevelopmental disorder, depression, bipolar disorder, or a psychotic disorder such as schizophrenia.

Read more to discover more about the symptoms and causes of catatonic depression, how it is diagnosed, and what the best available treatment options are.

Diagnosing Catatonic Depression

Although commonly associated with schizophrenia, catatonia is a specifier for several psychiatric and medical diagnoses. A healthcare professional will provide a thorough assessment to determine an accurate diagnosis and initiate the right treatment plan.

Doctors typically ask about what symptoms they are experiencing, when the symptoms first appeared, and anything that seems to make these symptoms improve or worsen. They will assess their behavior, motor activity, speech, mood, affect, thought process, thought content, perceptual disturbances, cognition, insight, and judgment.

A person who has catatonic symptoms may not be able to answer questions and the healthcare professional may need to talk to family members or loved ones about the person's symptoms.

Doctors must also rule out other conditions that may lead to similar symptoms, including infectious, metabolic, and neurological disorders. This may require medical tests, blood work, imaging studies, and so on. Catatonic symptoms can also be caused by certain medications.

Symptoms of Catatonia

Catatonia is a syndrome that includes many different signs and symptoms, some of which are fairly broad in nature. Possible manifestations can include:

• Stupor: Perhaps the most prominent sign is stupor. Stupor is characterized by a lack of mobility and speech.
• Posturing: Persons with catatonia are able to remain in the same posture for considerable periods of time.
• Waxy flexibility: The clinician who is examining someone with catatonia is able to position the individual in very uncomfortable poses which the individual will continue to maintain for a long period of time.
• Negativism: Attempts to move one of the catatonic person's body parts are met with resistance equal to the amount of strength that is being applied.
• Automatic obedience: People with catatonia automatically obey all instructions given by the examiner.
• Ambitendency: The person with catatonia alternates between cooperating with the examiner's instructions and resisting them.
• Psychological pillow: The catatonic individual lies down with their head a few inches above the bed, almost as if there is an invisible pillow resting under his head. This position can be maintained for an extended amount of time.
• Forced grasping: The individual repeatedly and forcibly grasps the examiner's hand when it is offered.
• Obstruction: The catatonic individual stops suddenly in the middle of a movement without any apparent reason for doing so.
• Echopraxia: This involves mimicking the actions of the person speaking.
• Aversion: A person with catatonia turns away when spoken to.
• Mannerisms: This symptom involves performing repeated, purposeful movements (e.g., saluting).
• Stereotypies: People with catatonia sometimes engage in repeated, non-purposeful movements (e.g., rocking).
• Motor perseveration: People with catatonia may also continue to make a particular movement even after it has lost its original relevance.
• Excitement: Another symptom of catatonia involves engaging in excessive and purposeless activity that is not driven by outside stimuli.
• Speech abnormalities: Speech may exhibit certain irregularities, such as repetition of what other people say or monotonous speech.

Causes of Catatonic Depression

While it is unknown exactly what causes people to become catatonically depressed, a number of theories have been put forth, including the following:

• Deficiency in gamma-aminobutyric acid (GABA)
• Dysregulation in glutamate
• Dysregulation in dopamine
• Abnormalities of metabolism in the thalamus and frontal lobes

One evolutionary theory suggests that catatonia may be due to an exaggerated primal fear response. It is possible, these scientists suggest, that our prehistoric ancestors, who had to frequently deal with predators, evolved the ability to remain very still for long periods of time in order to avoid detection by dangerous animals. Catatonia, they say, might be this ancient defense mechanism being triggered into action by strong feelings of fear.

Treatment for Catatonic Depression

In addition to treating depressive symptoms with traditional antidepressants, benzodiazepines and electroconvulsive therapy (ECT) are the two main treatments for catatonia, although certain other treatments, such as some atypical antipsychotics, may also be utilized.

Benzodiazepines

Benzodiazepines are the first-line choice for treating catatonia. They work by increasing the effects of the neurotransmitter GABA. This type of medication is also able to quickly provide relief for symptoms such as anxiety, sleeplessness, agitation, and muscle spasms. About 70% of people with catatonia do well with a benzodiazepine called Ativan (lorazepam).

Electroconvulsive Therapy (ECT)

Benzodiazepines are generally tried first, but ECT may be the first choice for malignant catatonia. ECT is performed under general anesthesia so that the individual does not experience any pain during the procedure.

Research suggests that benzodiazepines are an effective first-line treatment for catatonia and that ECT may be used as a second-line treatment if benzodiazepines are ineffective, but researchers suggest that ECT should be considered as a first-choice intervention in instances of severe catatonia. The two therapies—prescription medication and ECT—may also be combined.

Other Treatments

Some other treatments that may also be used include N-methyl-D-aspartate (NMDA) and repetitive transcranial magnetic stimulation (rTMS). Research suggests that N-methyl-D-aspartate (NMDA), an amino acid derivative and NMDA receptor agonist that mimics the actions of glutamate, shows some effectiveness in relieving catatonic symptoms.

rTMS is a noninvasive procedure in which magnetic pulses are directed toward certain areas of the brain. These magnetic currents are thought to stimulate brain cells in a way that may reduce depression and anxiety.

Such treatments are promising, but further research is needed to determine their effectiveness in treating catatonic depression.

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Coping With Catatonic Depression

Symptoms of catatonic depression are serious. If you suspect that you may be in the early stages of becoming catatonically depressed, the best thing you can do to cope is to get treatment as soon as possible from a medical or mental health professional. 

• Seek help: While you are experiencing symptoms of catatonic depression, you may need to be hospitalized. As you are recovering, you may continue to require assistance and supportive care. A friend or loved one may need to help you with daily living tasks and to help you get to and from your treatment appointments.
• Avoid triggers: Certain triggers, such as drugs and alcohol, can sometimes play a part in triggering catatonia or symptoms of severe depression. Focus on minimizing your exposure to things that tend to make your symptoms worse.
• Adhere to your treatment: Once symptoms begin to improve, you may be able to manage your condition with antidepressants and psychotherapy. These treatments focus on treating the underlying depression. Carefully following your treatment plan may help reduce the risk of additional catatonic episodes.
  

A Word From Verywell

While catatonia can be serious and life-threatening, the prognosis is good with appropriate treatment. While there is a lack of large-scale clinical studies examining current treatment approaches, the available research supports the effectiveness of both benzodiazepines and electroconvulsive therapy (ECT). New treatment protocols hold promise as well and research is underway.

Prompt recognition and treatment at the beginning of the catatonic state are essential for the best outcomes.