Catatonic Depression: Causes And Treatment
There are a few types of depressive disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Some are situational and pass with time and treatment. Others may be severe and have long-term symptoms. For some people, depression may be resistant to treatment. Although not an official diagnosis, catatonic depression is one of the more severe types of depression. In the DSM, it may be referred to as major depressive disorder with catatonic features.
Catatonic depression can cause individuals to feel so depressed that they remain speechless or motionless for long periods. This catatonic state can be concerning for the family and friends of those with the condition. There are a few reasons someone may become catatonic and several treatment options for those experiencing this state.
What's catatonic depression?
Catatonic depression refers to a type of major depression (major depressive disorder) where an individual goes into a catatonic state. This catatonic state may be characterized by a lack of movement or speech for long periods. In addition, the individual may not eat, drink, or care for themselves. In the past, catatonic depression was considered a unique disorder, but an understanding of the condition has changed over time.
Catatonic depression and symptoms of catatonia
In the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), catatonia was considered a subtype of schizophrenia. In the DSM-V, however, catatonia can be diagnosed as a specifier of other mental health conditions, including depression. Individuals with catatonia may show reduced gamma-aminobutyric acid (GABA) receptor density, contributing to these symptoms. People who have catatonic depression are often diagnosed with other mood disorders, such as bipolar disorder or clinical depression. These states of catatonia may also be associated with post-traumatic stress disorder (PTSD).
Several symptoms can help you identify catatonic depression. Persistent feelings of sadness are often present, which may occur daily and happen several times a week. It may require psychiatric care.
Symptoms of catatonia similar to depressive disorders
Other symptoms of catatonia may be shared with depression symptoms. For example, a loss of interest in activities that used to appeal to someone is a common symptom of depression. Problems maintaining an appetite or a persistent urge to eat can lead to sudden weight changes or other physical health concerns. Substance use, feelings of worthlessness and guilt, and trouble concentrating are other symptoms worth noting. Catatonic depression is also often associated with thoughts of suicide.
If you are experiencing suicidal thoughts or urges, call or text the 988 Suicide & Crisis Lifeline. Help is available 24/7.
Catatonic depression causes
Catatonic depression is often a result of other mental health disorders and medical conditions. The cause of catatonic depression may be examined from various angles. For example, the root of depression and the root of the catatonic state may differ. Looking at each of these root causes together, medical providers may get a clearer overall picture and understand why they’re occurring.
Catatonic depression: traumatic events, biological factors, and more
The cause of depression on its own can vary. Traumatic events, like the loss of a loved one, could be a contributing factor. Some people are prone to depression due to biological factors. Side effects from medications, abuse, illness, chemical imbalances in the brain, substance misuse, and other factors can also cause depression.
If you are facing or witnessing abuse of any kind, the National Domestic Violence Hotline is available 24/7 for support. Call 1-800-799-SAFE (7233) or text “START” to 88788. You can also use the online chat.
Treating catatonic depression with medication, electroconvulsive therapy, and more
If you have been diagnosed with catatonic depression, consider finding support and treatment to manage your symptoms. The types of treatment often effective for severe depression may include inpatient facilities, outpatient interventions, medication, talk therapy, and support groups. If you believe you’re living with catatonic depression, consider consulting with a mental health or medical professional, who can provide you with screenings and determine whether further testing, a diagnosis, treatment, or other steps are necessary.
Medication
Pharmacological solutions are typically a first-line treatment for catatonic depression symptoms. Medication may be combined with other forms of treatment depending on the person and the severity of their condition. Before starting, changing, or stopping medication, consult your primary care physician or a psychiatrist for guidance.
Electroconvulsive therapy (ECT)
In some cases, electroconvulsive therapy (ECT) is used as a treatment method. During electroconvulsive therapy, electric shocks are administered under general anesthesia to send electrical currents through the brain, which causes a brief seizure. This seizure can shock the brain out of the catatonic state it’s in. Electroconvulsive therapy is often viewed as an effective treatment, but many people only choose it as a last resort since it causes a seizure and may have side effects. However, many experts in the medical community see ECT as one of the safer options for treatment-resistant depression.
Transcranial magnetic stimulation (TMS)
Another medically reviewed treatment for catatonia and depression is transcranial magnetic stimulation, also known as TMS. In TMS therapy, wellness professionals utilize gentle magnetic pulses to stimulate parts of the brain that are inactive or underactive. These areas may be responsible for causing depression, as they can change how the individual responds to challenging situations.
TMS therapy can be a safe alternative to medication as it has virtually no side effects compared to alternative treatments. It has also been proven to have long-lasting results without requiring long-term treatment. The general treatment plan consists of five sessions a week for six weeks.
Talk therapy and treatment with mental health professionals
Coping with depression may be more manageable when you lean on a professional for guidance. If you’re struggling with symptoms that continue to hold you back, confiding in a professional about what you’re experiencing may be valuable. You can connect with a licensed therapist through a local mental health clinic, a one-on-one practice, or an online platform like BetterHelp. If you are experiencing depression, getting out of bed and attending an appointment can be difficult. In these cases, an online mental health professional can attend to you no matter where you’re located, as long as you have a smart device and an internet connection.
Internet-based interventions for bipolar disorder
In addition, internet-based interventions have been shown to be effective for treating various mental health conditions including mood disorders like depression and bipolar disorder. One study assessed the efficacy of a multimodal digital psychotherapy platform on adult depression. Researchers found that online platform users experienced significantly reduced depression symptom severity three months after beginning treatment.
Takeaway
Frequently asked questions (FAQs) about catatonic depression
Catatonic behavior is associated with a catatonic state. Catatonia is a severe psychiatric state in which a person has reduced reactivity to their environment. Although it is physically characterized by a lack of mobility, many other behaviors are commonly associated with catatonia. According to the DSM-V published by the American Psychiatric Association, other categories of catatonia symptoms may include stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerisms, stereotypy, agitation not influenced by external stimuli, grimacing, echolalia, and echopraxia.
Catatonic clients can develop moodiness or depressive symptoms that may last for an extended period. They may also become unaware of what is going on around them.
Several behaviors or attributes are often exhibited by a person living with catatonia. However, the behaviors or symptoms may not be the same for everyone. A few common catatonic symptoms can include:
- Extreme and prolonged sadness or moodiness
- Prolonged speech difficulty
- Difficulty moving the body
- Waxy flexibility (resistance to being repositioned)
- Abnormal movements
- Erratic actions (sudden yelling, jerking, etc.)
- Delusions or hallucinations
Are those experiencing catatonia aware and is it common in bipolar disorder?
People who are experiencing symptoms of catatonia may be mostly conscious of everything going on around them. However, they might not be responsive to their environment or the people around them. They may not reply when you speak to them, even if they hear you. While catatonia is historically associated with schizophrenia, research has found that it can result from multiple mental illnesses, including substance abuse, obsessive-compulsive disorder, post-traumatic stress disorders, and dissociative disorders. Catatonia is also commonly found in those with bipolar disorder..
Can catatonia be cured and get treatment for your mental health?
Catatonia can be treated. Seeking medical advice quickly can be essential for early detection of mental health or medical conditions that may be behind this condition. Medical professionals do not require any specific imaging or lab tests to diagnose catatonia, but there are techniques that can help doctors determine the underlying illness and distinguish it from conditions with similar symptoms, like neuroleptic malignant syndrome, a rare but life-threatening reaction to some antipsychotic medications.
Treatments can include medications or therapy, which are also standard options for treating depression. Catatonia may require emergency medical attention, acute psychiatric care, and psychiatric evaluation. Initial treatments include stopping the medications that may be contributing to catatonia and giving a dose of IV lorazepam. Some research has also found that intravenous dopamine can be an effective treatment for refractory depression with catatonic features with consequent bupropion for maintenance treatment.
Other potential treatments for catatonic patients include electroconvulsive therapy (ECT) or repetitive transcranial magnetic stimulation.
What is malignant catatonia?
According to the Journal of Intensive Care Medicine, malignant catatonia “describes catatonia that presents with clinically significant autonomic abnormalities including change in temperature, blood pressure, heart rate, and respiratory rate. It is a life-threatening form of acute brain dysfunction that has several motoric manifestations and occurs secondary to a primary psychiatric condition or a medical cause.”
Warning signs of malignant catatonia include dangerously high fever, rapid heart rate, sweating, unable blood pressure, and low blood oxygen.
What is a catatonic episode like?
Catatonia can be a difficult psychiatric classification to identify. Generally, people with catatonia do not respond to external stimuli or have normal functioning while they are awake. While there are common symptoms, people with this condition can experience it in many ways.
According to the DSM-V, there are 12 recognized symptoms of catatonia. To be diagnosed with catatonia, someone must exhibit three or more of the following symptoms:
- Stupor: This is when someone is awake but does not respond to what is happening around them or to them, including pain.
- Waxy flexibility: Waxy flexibility is when someone resists attempts to change their position by slowly releasing their muscles, causing them to move in a way that resembles bending warm wax.
- Catalepsy: This symptom occurs when someone holds a position that someone else puts them in.
- Mutism: Mutism is when a person makes minimal or no noises at all and can be a symptom of catatonia if it is not related to another condition.
- Posturing: This is when someone holds a specific abnormal position that would be uncomfortable to someone who is not catatonic.
- Negativism: Negativism is when someone does not react to stimuli around them or resists what is happening for no rational reason.
- Stereotypy: This occurs when someone engages in repetitive, purposeless movements.
- Mannerisms: Mannerisms is when someone acts out movements in an unusual or exaggerated way.
- Grimacing: This occurs when someone holds the same facial expression, usually with stiff facial muscles.
- Agitation: Agitation can be a symptom of catatonia if it does not happen in response to an external stimuli. This can also refer to psychomotor agitation, which is when someone experiences increased restlessness or irritability that may be in response to internal and external stimuli.
- Echopraxia: Echopraxia is when someone mirrors someone else’s movements.
- Echolalia: This is when someone echoes the sounds, words, or phrases someone else makes.
The characteristics of a catatonic episode will also depend on the type of catatonia. The most common type is akinetic catatonia, in which the person stares and appears to be non-responsive. While people with this type are awake and aware of their surroundings, they have minimal or no response to stimuli.
What is an example of catatonia?
Catatonia affects people in many ways. People may repeat or echo another person's speech, hold unusual body positions, repeat the same phrases or motions for an extended period of time, or have marked disturbances in motor activity.
What does going catatonic feel like?
It can be difficult to understand what a catatonic episode feels like unless you have experienced one. Some people have shared their experiences, like in this post for the National Alliance of Mental Health. Researchers suggest that people with catatonia experience intense emotional states, with people reporting having intense emotions that they could not control. In studies, people have reported feeling extreme anxiety and like they were going to die or were already dead, while other researchers have described it as a state of extreme fear where people freeze.
Is catatonia caused by anxiety?
Yes, catatonia can be caused by anxiety and underlying depression as well as a number of other mental health conditions, but the changes in the brain that cause it are not fully understood by experts and medical reviewers. Some studies have identified dysfunction in the frontal lobes in people with catatonia, and research suggests that the dysfunction of some chemical transmissions, like GABA neurotransmitter (gamma aminobutyric acid), serotonin, or dopamine, may cause or contribute to the condition. One subtype called periodic catatonia may be tied to genetics and can be diagnosed if someone has a family history of the condition.
In addition to anxiety and other mental health conditions, risk factors for catatonia include some medical conditions, like low sodium, liver transplantation, and a rare type of stroke called cerebral venous sinus thrombosis. People who take certain medications for mental health conditions are also at risk of catatonia if they experience withdrawal after stopping these medications suddenly.
Methods for treating catatonia generally depend on what causes it. Treating an underlying neurological or medical condition can reverse catatonia, but in some cases, the catatonia must be treated first.
Medications called benzodiazepines are commonly used to relieve symptoms of catatonia, as they are both safe and effective and have anxiety-relieving and muscle-relaxing qualities. Other medications, like mood stabilizers, may be used after initial symptoms improve to prevent a recurrent episode or treat symptoms of other mental health conditions, like low mood or energy in major depressive disorder.
Antipsychotic medications are not an appropriate treatment during catatonia as they can cause severe life-threatening consequences.
Electroconvulsive therapy (ECT) is another possible treatment for catatonia. This procedure involves running a mild electric shock through specific areas of the brain to cause a short seizure. ECT is very effective and is the main treatment for people with malignant catatonia or for those who are not responding to medication.
What triggers catatonia?
Experts are not sure what causes catatonia, so the current understanding is that it is not possible to prevent it or reduce the risk of it happening.
If you are concerned about your mental health, talk to your doctor or reach out to a therapist who can help you learn how to manage your symptoms and life a healthy lifestyle to support your mental healthhealthy lifestyle. You may also find support and additional mental health resources through the Substance Abuse and Mental Health Services Administration and the Anxiety & Depression Association of America.
- Previous Article
- Next Article