Catatonic depression is defined as a state of stupor that results from neurogenic motor immobility and is thought to be caused by dysregulation of the neurotransmitters: GABA, glutamate and dopamine in the brain. It was first recognized in 1874 by Karl Ludwig Kahlbaum. In the current DSM (Diagnostic and Statistical Manual of Mental Disorders), “catatonia” itself is not regarded as a distinct disorder. It is however grouped in association with various disorders such as: schizophrenia, bipolar disorder, PTSD, and depression.
If you are classified as being depressed with catatonic features, it simply means that you are experiencing this state of mental stupor in addition to your depression. This is a difficult condition to deal with, but in cases of depression, the root cause must be analyzed and attempted to be addressed. It should also be noted that this is a pretty rare condition for someone to experience with depression. It is estimated that less than 10% of all psychiatric patients end up developing conditions with catatonic features.
Catatonic Depression Symptoms
In cases of depression with catatonic features, we aren’t sure as to what could cause the cataonia to manifest. Catatonic features can be a result of medication treatment, cognitive decline, and/or other imbalances of neurotransmitters. The main irregularities have been linked to amounts of dopamine, GABA, and glutamate. Below is an extensive list of symptoms that people may experience if they have catatonic depression.
- Abnormal speech: The speech of someone with catatonia is often monotonous and/or repetitive. It is pretty easy to notice irregularities in verbal communication.
- Ambitendency: Patients can alternate between periods of cooperating with a psychiatrist and resisting them.
- Automatic obedience: All instructions given to a patient are obeyed without question.
- Aversion: A person may turn away when they are spoken to. For example, if you talk to the person with catatonic symptoms, they may turn their head and look in another direction.
- Echolalia: This involves mimicking another person’s speech.
- Echopraxia: This involves imitating another individual’s patterns of movement.
- Excitement: Individuals may engage in purposeless and (seemingly excessive) activities that are not influenced by outside stimuli or interaction.
- Forced grasping: A person may repeatedly grasp a psychiatrist’s hand with force when it is offered.
- Loss of appetite: People may refuse to eat or claim to not have an appetite.
- Obstruction: A person may stop or “pause” suddenly in the middle of a body movement without any reasoning.
- Psychological pillow: People with catatonic features may lie down with their head a few inches above the bed as if there were an “invisible pillow” underneath their head. This position may be held for a long period of time.
- Hypokinesis: Immobility, extreme rigidity, and being unable to move. This is a common symptom experienced by people with cataonia.
- Mannerisms: This involves repeated, purposeful movements such as “praying” or “saluting.”
- Motor perseveration: Individuals may continue to make a particular movement even though it is no longer relevant to conversation or communication.
- Negativism: When someone attempts to move the catatonic patient, the force to which they try to move the person is met by an equal or greater force from the patient.
- Posturing: People remain in the same position for hours at a time without moving.
- Selective Mutism: This involves a person not being able to speak due to feelings of extreme fear and anxiety.
- Sloth-like movement: Some people may move so slowly with this condition that it takes them several hours just to “sit up” while in bed.
- Stereotypy: Performing ritualistic or repeated non-purposeful movements. A common example is “rocking” back and forth.
- Stupor: This is perhaps the most common indicator that someone is in a catatonic state. Stupor is defined as lacking in both speech and mobility. Sometimes people are referred to as being in a “catatonic stupor.”
- Unusual movements: Upon observation of people in a catatonic state, they may appear to move their body oddly at times.
- Waxy flexibility: Someone examining the patient will see that the person with catatonia maintains uncomfortable positions for long periods of time. The reason it’s called “waxy flexibility” has to do with the fact that you could move someone’s arm or leg with catatonia and they would keep it locked in that position. In other words, you can bend them like “wax” and they will hold the position.
What causes catatonic depression?
It is thought to be linked to deficiencies in GABA, glutamate, and dopamine – all important neurotransmitters in the brain. Some also hypothesize that irregularities in the metabolism of the thalamus as well as the frontal lobes can lead to this condition. Another theory is that the entire condition is caused as a result of an excessive fear response.
Back when humans were cavemen, they sometimes had to deal with predators and in order to stay safe, they had to remain extremely still for long periods of time. It is thought that this mechanism of evolution may be at play in people with catatonic features.
Catatonic Depression Treatment Options
The two main treatment options for catatonic depression are benzodiazepines (e.g. Xanax) and electroconvulsive therapy (ECT). Atypical antipsychotics are also utilized in certain cases as they are thought to help manage some of the symptoms.
- Benzodiazepines: This is the first line of treatment for catatonia. They help increase levels of the GABA neurotransmitter in the brain. This is a medication primarily used for symptoms of anxiety disorders and stress. Roughly 3/4 people treated with a benzodiazepine medication find relief from catatonia.
- Electroconvulsive Therapy (ECT): This is considered the most effective way to treat catatonia, but there are a number of other risks associated with ECT. This treatment option works in over 4/5 of individuals. Typically benzodiazepines are administered before ECT is tried, but they may be used in combination as well.
- Atypical antipsychotics: In some cases, a psychiatrist may administer an atypical antipsychotic. Although this is more common in cases of schizophrenia, it can be used as an effective augmentation strategy for depression. These are not found to directly help with catatonic symptoms, but may address a different underlying issue.
For an ideal treatment outcome, it is best to recognize catatonia as soon as possible and get it treated. The longer a person goes without treatment, the greater the difficulty they may experience in overcoming the symptoms.