A Comprehensive Guide on Catatonic Depression

Depression is a complex mental health condition that can come in many ways. The most common is Major Depressive Disorder, but women who give birth can also experience Postpartum Depression, some people can be affected by Seasonal Affective Disorder, and some people can have dysthymia.

So there’s no singular way in which depression can present itself. It can even be part of different medical conditions entirely, as episodes of depression are symptoms of Bipolar Disorder.

At PROMIS, we understand that your mental health is a serious concern for you. Our programs are designed to help you manage the litany of symptoms that you may experience.

An Overview of Depression

At its core, depression is characterized by great sadness. People who have depression will feel hopeless and empty inside. They may have a hard time doing anything because their depression causes them to feel fatigued or they simply don’t see the point in doing anything. In truly severe cases, depression can also cause suicidal ideation.

The effect that a mood disorder such as depression can have on someone’s life can be profound. A person who has it can experience professional and personal setbacks if they are unable to manage their symptoms.

What is Catatonic Depression?

Catatonic Depression, or catatonia, is a subtype of Major Depressive Disorder that is characterised by abnormal movement. This form of depression can be incredibly debilitating and people who have it are at risk for dehydration, malnutrition, and self-harm due to impaired motor function and communication abilities.

Signs and Symptoms of Catatonic Depression

Catatonic depression can be identified by a number of motor and behavioural abnormalities. The symptoms of catatonia can include:

• Stupor: People who experience catatonic depression can appear to not react to external stimuli. In effect, they can become completely immobile for a period of time.
• Mutism: Catatonia can also impair a person’s verbal communication, either stopping it entirely or reducing it significantly.
• Negativism: Catatonic people can appear to become resistant to being moved. To another person, they can seem as if they are being uncooperative or rigid.
• Posturing: Catatonic depression can also make people assume strange postures for extended periods of time.
• Waxy flexibility: If they’re not completely resistant to being moved in any way, people with catatonia can adopt waxy flexibility. This means that if someone moves a part of their body in some way, they’ll maintain that position like they’re made of wax.
• Catalepsy: People with catatonic depression can sometimes maintain positions that act against gravity for extended periods, even if the position is uncomfortable or awkward to maintain.
• Agitation: Catatonia can also cause people to make sudden movements, be restless, and pace around.
• Echolalia: Someone in a catatonic state may start repeating someone else’s words, like an echo.
• Echopraxia: In the same vein as above, someone with catatonic depression can start mimicking the movements of others.
• Executive Dysfunction: Catatonic depression may make a person unable to follow through on activities, even if they start with the intention of finishing it.
• Stereotypy: People who have catatonic depression can move in a way that can be interpreted as ritualistic.
• Unusual mannerisms: People who have catatonia can move or speak in ways that aren’t normal for them.

Types of Catatonic Depression

Catatonic depression can come in a number of ways and they can be identified based on what symptoms they present. Akinetic catatonia is the most common form of catatonic depression. This is when a person exhibits the symptoms that restrict their movements and their speech. This can also lead to conditions such as Deep Vein Thrombosis (DVT) and Pulmonary Embolus (PE).

Excited catatonia is when they become restless and hyperactive. This is a particularly dangerous type of depression as someone can hurt themselves or others because patients who have this form of catatonia may become aggressive or violent.

The most dangerous form of catatonia is likely malignant catatonia. This is when a person suffers extreme stupor or immobility and may also experience suicidal ideation or psychosis alongside it. This type of depression can be characterised by a fever, abnormal blood pressure, abnormal breathing, abnormal sweating, and delirium.

It should be noted that the symptoms of malignant catatonia can overlap with Neuroleptic Malignant Disorder so it’s important to seek the help of a medical professional and get an individual’s detailed medical history to tell the difference between the two.

Causes of Catatonia

What can cause catatonia is not yet fully understood. Presently, it’s believed to be a malfunction of the neurotransmitters gamma-aminobutyric acid (GABA) and glutamate, both of which regulate motor function and behaviour.

There are underlying medical conditions that cause the onset of catatonic symptoms such as mood disorders like Bipolar Disorder. Catatonia can also be a feature of schizophrenia, a mental disorder that disturbs thinking, emotions, and behaviour. 

Some neurological conditions such as encephalitis, brain tumors, stroke, or traumatic brain injury (TBI)u can affect how the brain functions and lead to disturbances in motor function and behaviour. Medical conditions such as hyperthyroidism, lupus, neurosyphilis, substance use and withdrawal can also lead to catatonia.

There are some medications that can induce catatonia. These medications include antipsychotics, antidepressants, or benzodiazepines. There are some cases of idiopathic catatonia, which is when the cause is not readily identifiable.

Treatment for Catatonic Depression

While the exact causes of catatonia are not well understood, there are some treatment options that a doctor may use. Some of the options to treat catatonia can include:

Medication

The first-line treatment for catatonia is typically a benzodiazepine like lorazepam or clonazepam. This is because they can rapidly reduce catatonic symptoms. Traditional antidepressants like Selective Serotonin Reuptake Inhibitors (SSRIs) can also be used for depression symptoms, but they may not be as effective when someone is in a catatonic state. 

Other medications can also be used if the catatonia in question is symptomatic of another medical condition.

Electroconvulsive Therapy (ECT)

For patients who have severe catatonic symptoms, doctors may opt for Electroconvulsive Therapy (ECT). This is a type of therapy wherein an electrical current is administered to the brain while the patient is under general anaesthesia, resulting in a controlled seizure.

ECT is believed to modulate neurotransmitter activity and promote neuroplasticity, leading to improvements in mood and motor function. ECT is quite effective, with some research finding it to be between 80 to 100 per cent effective even after medication has failed.

Hospitalisation

In truly severe cases, such as when immobility puts a person at risk for dehydration or malnutrition, a patient may need to be hospitalised so they can provided with intensive medical and psychiatric care around the clock.

Physical Therapy

Because of how catatonia can affect motor function, people who suffer from it can benefit from physical therapy. Physical therapy can help improve someone’s mobility, strength, and coordination.

Therapy and Medication when Catatonic Symptoms Subside

Some forms of therapy such as Cognitive Behavioural Therapy (CBT), psychodynamic therapy, and supportive therapy can be beneficial for people who suffer from catatonia. Therapy can be beneficial for understanding and addressing underlying depression once catatonia symptoms improve. A patient may also be prescribed traditional antidepressants.  

Because of how catatonia can be caused by other conditions, it’s important to note that a patient who presents with symptoms should be taken to a medical doctor immediately to be properly diagnosed and treated.

Coping with Catatonia

Coping with catatonia in everyday life can be a mixture of sticking to the treatment plan as prescribed by a medical professional and coping with the underlying depression. Above all, if you’re suffering from this, you need patience. The lifestyle changes, therapy, and medication that you may have to use to treat depression may take time to take effect, but they’ve all proven to be effective at treating depression.