Catatonic Depression

Catatonic depression is a type of depression that causes someone to remain speechless and motionless for an extended period. Although catatonic depression used to be seen as a distinct disorder, the American Psychiatric Association (APA) no longer recognizes it as a separate mental illness. Instead, the APA now considers catatonia to be a specifier for various mental illnesses, including depression, post-traumatic stress disorder, and bipolar disorder. Catatonia is characterized by an inability to move normally. The symptoms of catatonia can include:

  • staying still
  • a lack of speech
  • fast movements
  • abnormal movements

Symptoms of Catatonic Depression

Symptoms

If you have catatonic depression, you may experience the symptoms of depression, such as:

  • feelings of sadness, which can occur nearly every day
  • a loss of interest in most activities
  • sudden weight gain or loss
  • a change in appetite
  • trouble falling asleep
  • trouble getting out of bed
  • feelings of restlessness
  • irritability
  • feelings of worthlessness
  • feelings of guilt
  • fatigue
  • difficulty concentrating
  • difficulty thinking
  • difficulty making decisions.
  • thoughts of suicide or death
  • a suicide attempt

You may also experience symptoms of catatonia, including:

  • extreme negativism, which means a lack of response to stimuli or an opposition to stimuli
  • agitation
  • an inability to move
  • difficulty speaking due to extreme anxiety
  • unusual movements
  • imitating another person's speech or movements
  • a refusal to eat or drink

People with severe catatonia may have difficulty completing daily tasks. For example, the simple act of sitting up in bed may take hours.

Causes of Catatonic Depression

Causes

Researchers believe depression is partly caused by an irregular production of neurotransmitters. Neurotransmitters are chemicals in the brain that allow cells to communicate with each other. The neurotransmitters most often associated with depression are serotonin and norepinephrine. Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), work by acting on those two particular chemicals.

Catatonia is believed to be caused by irregularities in the dopamine, gamma-aminobutyric acid (GABA), and glutamate neurotransmitter systems. It’s often accompanied by an underlying neurological, psychiatric, or physical illness. As a result, your doctor must focus on the cause to treat catatonic symptoms successfully.

Treatments for Catatonic Depression

Treatment

The following treatments are available for catatonic depression:

Benzodiazepines

Benzodiazepines are a class of psychoactive drugs that enhance the effect of the gamma-aminobutyric acid (GABA) neurotransmitter. In most people, these medications are effective for quickly relieving catatonic symptoms, including anxiety, muscles spasms, and insomnia. However, benzodiazepines are also highly addictive, so they’re usually used as a short-term treatment method.

Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is by far the most effective treatment for catatonic depression. It involves attaching electrodes to the head that send electrical impulses to the brain, triggering a mild seizure. Although ECT is now considered a safe and effective treatment for a range of mood disorders and mental illnesses, there’s still a stigma surrounding it. As a result, it currently lags behind benzodiazepine as the primary treatment for catatonic symptoms. However, a combination of benzodiazepine and ECT may be the best treatment for catatonic depression.

N-Methyl-D-Aspartate

There’s increasing amounts of evidence showing that N-methyl-D-aspartate (NMDA) can be used to treat catatonic depression effectively as well. NMDA is an amino acid derivative that mimics the behavior of the glutamate neurotransmitter. Although it appears to be a promising treatment method, more studies are needed to address its effectiveness and side effects adequately.

Repetitive Transcranial Magnetic Stimulation (rTMS)

Other treatments that have shown promise are repetitive transcranial magnetic stimulation (rTMS) and certain atypical antipsychotics, particularly those that block dopamine D2 receptors. However, more research is necessary to determine how effective these methods are in treating people with catatonic depression.