Catatonic depression is a subtype of depression in which a person does not speak or may appear to be in a daze for a prolonged period of time. Depression causes a person to experience a very low mood.

Sometimes, depression can be accompanied by catatonia, which is when a person does not respond to the world around them. The word catatonia comes from two Greek terms, kata, which means down, and tonas, which means tension or tone. Some people call this being in a “catatonic state.”

In this article, learn about the symptoms of catatonic depression, treatment options and how to cope.

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Catatonic depression is a subtype of depression where a person does not speak or appears to be in a daze for a prolonged period.

A person with catatonic depression does not respond to what is happening around them and may be silent and motionless.

Doctors classify mental health disorders and dysfunctions using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5TR).

Doctors now recognize that catatonia can accompany many mental health conditions, including schizophrenia, depression, mood disorders, and personality disorders. Catatonia can also occur without an associated condition.

The most common symptoms associated with catatonia are mutism (not speaking) and stupor (the state of being in a daze).

For a doctor to diagnose catatonia, the person must have at least three of the following 12 symptoms:

AgitationA feeling of anxiety or restlessness.
CatalepsyBeing in a trance-like state
EcholaliaSenseless repetition of the words another person says
EchopraxiaMeaningless repetition of movements another person does
GrimacingMaking a face that looks like a person is in pain
MutismInability or refusal to speak
NegativismAdopting behaviors that are the opposite of their emotions
PosturingAdopting a rigid or unnatural posture for extended periods
StereotypyRitualistic movements, such as rocking
StuporLower response to stimuli
Unusual mannerismsIrregular speech or movement patterns
Wavy flexibilityLack of response to commands and immobility

A person with catatonic depression will probably also experience classic depression symptoms, such as feeling low or sad. They may also experience a sense of hopelessness.

Depression can affect a person’s appetite, sleep levels, concentration, and movement.

Doctors do not know what causes catatonic depression.

Depression can be due to a combination of several factors, including:

  • changes in brain structure or functioning, which may make the brain less responsive to certain hormones
  • a family history of depression or other mental health conditions
  • significant life changes, such as the death of a loved one or a divorce
  • additional medical conditions, such as problems sleeping, chronic pain, chronic illness, or attention deficit hyperactivity disorder

Some researchers believe that catatonia and depression symptoms are due to dopamine depletion. Dopamine is a neurotransmitter in the brain that has associations with brain function and mood regulation.

While there is no evidence that low dopamine levels directly cause depression, they can lead to symptoms related to depression, including:

  • difficulty concentrating
  • lack of motivation
  • low mood

Often, a person with catatonic depression cannot respond to questions a doctor may ask them.

Therefore, a doctor may begin a diagnosis by asking the person’s loved ones about the symptoms. The doctor might ask when the symptoms first appeared and what makes them worse or better.

A doctor will also try to rule out other medical conditions that have similar symptoms to catatonic depression.

For example, neuroleptic malignant syndrome can occur if a person has an adverse reaction to antipsychotic medications. This condition has similar symptoms to catatonic depression.

The doctor may also order imaging studies to ensure a person does not have a brain tumor or another condition that could cause catatonia.

A doctor will also observe a person’s posture, listen to any communication they may make, and watch their movements.

Doctors often prescribe benzodiazepines as the first-line treatment for catatonia. Benzodiazepines, such as lorazepam (Ativan), have anxiety-relieving and muscle-relaxing properties. A doctor can administer the medication intravenously if a person cannot take it orally.

If medication is ineffective, a doctor may recommend electroconvulsive therapy (ECT). Doctors perform this therapy under general anesthesia, meaning a person is asleep and feels no pain during the procedure.

During ECT, doctors use electrical currents to induce a seizure. Although doctors do not fully understand how ECT works, many believe it works by “resetting” the brain’s chemistry and may help people with severe mental illness respond better to treatment.

According to a 2016 review, ECT was effective in treating 80-100% of all forms of catatonia.

Doctors may also try other brain stimulation methods, such as transcranial magnetic stimulation or deep brain stimulation, to reduce catatonia symptoms.

Once a person’s catatonia symptoms improve, a doctor may prescribe antidepressants and psychotherapy to treat the underlying depression.

This drug has boxed warnings. These are the most serious warnings from the Food and Drug Administration (FDA). Boxed warnings alert doctors and patients about drug effects that may be dangerous.

  • Taking benzodiazepines with opioid drugs increases your risk for severe sleepiness, respiratory depression, coma, and even death. Alprazolam shouldn’t be taken with an opioid unless there are no other available treatment options.
  • Using benzodiazepines, even as prescribed, can lead to physical dependence and withdrawal if you stop taking the drug suddenly. Withdrawal can be life threatening.
  • Taking benzodiazepines can also lead to misuse and addiction. Misuse of [drug name] increases your risk of overdose and death.
  • Only take benzodiazepines as your doctor prescribes. Talk with your healthcare provider if you have any concerns about safely taking this drug.

People with catatonia are at risk for various complications if they do not receive treatment.

Possible complications include:

A person with catatonic depression requires acute psychiatric care. A loved one may need to call an inpatient psychiatric center or seek emergency medical attention to help the person get treatment as soon as possible.

If a person suspects their loved one is in a catatonic state, they should contact their primary care physician or seek emergency medical attention.

Catatonic depression is a severe but treatable subcategory of depression. Benzodiazepines and ECT can help relieve symptoms in many cases.

People with catatonic depression may need long-term treatment for depression or other mood disorders, even after the symptoms of catatonia have improved.

When a person is catatonic, they do not respond to, or engage with, the world around them. A person may experience catatonia alongside depression. This is catatonic depression.

The exact physiological causes of catatonia and depression are not clear. However, traumatic events, a person’s family history, and changes in brain functioning may all play a part.

Doctors can effectively treat most cases of catatonia with a combination of benzodiazepines and electroconvulsive therapy.