Catatonic depression: What to know
The word catatonia comes from two Greek terms, kata, which means down, and tonas, which means tension or tone.
In this article, learn about the symptoms of catatonic depression, as well as treatment options and how to cope.
What is catatonic depression?
A person with catatonic depression may be silent and motionless.
Catatonic depression is a subtype of depression characterized by not speaking or seeming to be in a daze for a prolonged period.
A person with catatonic depression does not respond to what is going on around them and may be silent and motionless.
Doctors classify mental health disorders and dysfunctions using criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).
Catatonia used to be a separate subtype of schizophrenia. However, doctors now recognize that catatonia can accompany many different mental health conditions, including schizophrenia, depression, mood disorders, and personality disorders.
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:
- Agitation, or anxiety or restlessness.
- Catalepsy, or being in a trance-like state.
- Echolalia, or senseless repetition of the words another person says.
- Echopraxia, or the meaningless repetition of movements another person does.
- Grimacing, or making a face that looks like a person is in pain.
- Mutism, or the inability or refusal to speak.
- Negativism, or adopting behaviors that are the opposite of their emotions. For example, feeling hungry but refusing to eat.
- Posturing, such as adopting a rigid or unnatural posture, often for extended time periods.
- Stereotypy, or ritualistic movements, such as rocking or crossing and uncrossing the legs repeatedly.
- Stupor, or decreased response to stimuli, including when people talk to the person.
- Unusual mannerisms, such as irregular speech patterns or movements or staring.
- Wavy flexibility, where a person does not respond to commands and has an immobile posture.
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.
The death of a loved one may put a person at risk for developing depression.
Doctors do not know exactly what causes catatonic depression, though there are some theories.
Some researchers believe that catatonia and depression symptoms are due to the depletion of dopamine. Dopamine is a neurotransmitter in the brain associated with mood.
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
People with a history of drug and alcohol addiction are also at greater risk for depression.
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, a condition called 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.
Treatment and recovery
Benzodiazepines are a common first-line treatment for catatonia.
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 medicine intravenously (IV) if a person is unable to take it orally.
If medication is not effective, 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 that it works by "resetting" the brain's chemistry and may help people with severe mental illness respond better to treatment.
According to an article in the World Journal of Psychiatry, ECT was effective in treating 80 to 100 percent 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.
People with catatonia are at risk for a range of complications if they do not receive treatment.
Possible complications include:
- blood clots
- contractures, or shortening of muscles or tendons
- decubitus ulcers
Caring for someone with catatonic depression
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.