What is catatonic depression?

Catatonic depression is a type of depression that makes one  motionless and speechless for an extended period of time.

Catatonic depression used to be viewed as a distinct disorder, but currently the American Psychiatric Association doesn’t recognize it as a separate mental disorder. Instead, the APA considers catatonia to be a subcategory for different mental illnesses, including depression, PTSD, and bipolar disorder.

The clinical syndrome of ‘Katatonie’ was first formulated by Karl Ludwig Kahlbaum.

“... the patient remains entirely motionless, without speaking and with a rigid, masklike facies, the eyes focused at a distance; he seems devoid of any will to move or react to any stimuli; there may be a fully developed "waxen" flexibility, as in cataleptic states, or only indications of this striking phenomenon. ...the general impression conveyed by such patients is one of profound mental anguish or immobility induced by severe mental shock ... Once the clinical signs are manifest, they tend to persist, although in some patients they appear for relatively short periods and then tend to recur. The obvious association of this illness with other signs of disease, and its constant occurrence with certain somatic (particularly muscular) disorders, have been more or less ignored.”

As you see, Catatonia is characterized by an inability to move normally; its symptoms include stillness, a lack of speech, and abnormal movements. It is a common syndrome seen in a variety of psychiatric illnesses, especially in the setting of mood disorders. It is estimated that nearly 50% of patients with catatonia struggle with an underlying bipolar affective disorder. About 20-30% of bipolar affective disorder patients experience catatonia at some point during their illness. Due to some statistics, nearly 90,000 cases of catatonia occur in US hospitals every year.

Catatonic depression symptoms

Catatonic depression may occur spontaneously. It can be recognized by the combination of some of the following symptoms:

– Low mood  

– Irritability

– No interest in pleasurable activities

– Low energy levels

– Feeling worthless 

– Inability to focus

– Thoughts of death

– A rigid and still posture that looks odd or abnormal. 

– No verbal responses

– No response to instructions or stimuli 

– Overly exaggerated actions

Catatonic depression treatment

The treatment for catatonic depression varies from person to person depending on the individual’s symptoms and the severity. 

Catatonic depression often responds well to psychotropic drug therapies, including benzodiazepines. According to a review examining treatments of catatonia in 178 patients, the most common intervention was the use of benzodiazepines with a reported 70 percent response rate. 

When depression is complicated by catatonia, neurostimulation also provides a high success rate for relieving symptoms. Electroconvulsive therapy (ECT), a form of neurostimulation therapy, can be a successful treatment for people with severe depression who need immediate help or people who aren’t improving with medication and psychotherapy alone. 

Benzodiazepines and ECT both affect GABA neurotransmission, which results in an increased seizure threshold and decreased cortical excitability. A combination of both treatment methods may be advantageous, but how they can be best combined still remains uncertain. In general, there is no single treatment for catatonic depression and patients may find the most benefit from different therapies used at the same time.

In case you want to learn more about Benzodiazepine treatment for catatonic depression in the elderly, you can read it on easap.asia.

Anton Kurapov

Anton Kurapov

PhD, a professor assistant at Taras Shevchenko National University of Kyiv. Fascinated by the role of psychology in lives of people and simply astonished by the complexity of the brain and its functions.

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