Table of ContentsView AllTable of ContentsDiagnosing Catatonic DepressionSymptoms of CatatoniaCauses of Catatonic DepressionTreatment for Catatonic DepressionCoping

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Table of Contents

Diagnosing Catatonic Depression

Symptoms of Catatonia

Causes of Catatonic Depression

Treatment for Catatonic Depression

Coping

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Catatonic depression is when catatonia occurs concurrently withdepression. Catatonia is a state in which a person experiences marked disturbances in motor activity. Although generally thought of as reduced engagement and activity, it may also manifest as excessive or peculiar motor symptoms.

Catatonia can be a part of another mental disorder or medical condition, or it may be categorized as “unspecified.” Unspecified catatonia includes all cases in which there is no major psychotic, affective, or medical disorder that can be diagnosed.

Catatonia itself is not uncommon, affecting about 10% of people with psychiatric conditions in Western countries. People with symptoms of catatonia typically have a neurodevelopmental disorder, depression,bipolar disorder, or a psychotic disorder such asschizophrenia.

Read more to discover more about the symptoms and causes of catatonic depression, how it is diagnosed, and what the best available treatment options are.

Although commonly associated with schizophrenia, catatonia is aspecifierfor several psychiatric and medical diagnoses. A healthcare professional will provide a thorough assessment to determine an accurate diagnosis and initiate the right treatment plan.

Diagnosing catatonic depression means the person meets the criteria formajor depressive disorderwhile other potential mental or physical disorders have been ruled out. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), the diagnosis may look something like this: “major depressive disorder, recurrent episode, severe, catatonic.”

Doctors typically ask about what symptoms they are experiencing, when the symptoms first appeared, and anything that seems to make these symptoms improve or worsen. They will assess their behavior, motor activity, speech, mood, affect, thought process, thought content, perceptual disturbances, cognition, insight, and judgment.

A person who has catatonic symptoms may not be able to answer questions and the healthcare professional may need to talk to family members or loved ones about the person’s symptoms.

The DSM-5-TR specifies that the diagnosis of depression with catatonia requires to patient to meet the criteria for major depression with the presence of at least three psychomotor symptoms related to catatonia.

Catatonia is a syndrome that includes many different signs and symptoms, some of which are fairly broad in nature. Possible manifestations can include:

Recap

While it is unknown exactly what causes people to become catatonically depressed, a number of theories have been put forth, including the following:

If you or a loved one are struggling with depression, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.For more mental health resources, see ourNational Helpline Database.

If you or a loved one are struggling with depression, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.

For more mental health resources, see ourNational Helpline Database.

In addition to treating depressive symptoms with traditional antidepressants, benzodiazepines and electroconvulsive therapy (ECT) are the two main treatments for catatonia, although certain other treatments, such as someatypical antipsychotics, may also be utilized.

Benzodiazepines

Benzodiazepine Uses, Indications, and Side Effects

Electroconvulsive Therapy (ECT)

Benzodiazepinesare generally tried first, but ECT may be the first choice for malignant catatonia. ECT is performed under general anesthesia so that the individual does not experience any pain during the procedure.

ECT is the most efficacious treatment available for catatonia. Research suggests that it works for about 80% to 100% of people with catatonia.

Research suggests that benzodiazepines are an effective first-line treatment for catatonia and that ECT may be used as a second-line treatment if benzodiazepines are ineffective, but researchers suggest that ECT should be considered as a first-choice intervention in instances of severe catatonia.The two therapies—prescription medication and ECT—may also be combined.

Electroconvulsive Therapy (ECT): Definition, Types, Techniques, Efficacy

Other Treatments

Some other treatments that may also be used include N-methyl-D-aspartate (NMDA) and repetitive transcranial magnetic stimulation (rTMS). Research suggests that N-methyl-D-aspartate (NMDA), an amino acid derivative and NMDA receptor agonist that mimics the actions of glutamate, shows some effectiveness in relieving catatonic symptoms.

rTMS is a noninvasive procedure in which magnetic pulses are directed toward certain areas of the brain. These magnetic currents are thought to stimulate brain cells in a way that may reduce depression and anxiety.

Such treatments are promising, but further research is needed to determine their effectiveness in treating catatonic depression.

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Coping With Catatonic Depression

Symptoms of catatonic depression are serious. If you suspect that you may be in the early stages of becoming catatonically depressed, the best thing you can do to cope is to get treatment as soon as possible from a medical or mental health professional.

A Word From Verywell

While catatonia can be serious and life-threatening, the prognosis is good with appropriate treatment. While there is a lack of large-scale clinical studies examining current treatment approaches, the available research supports the effectiveness of both benzodiazepines and electroconvulsive therapy (ECT). New treatment protocols hold promise as well and research is underway.

Prompt recognition and treatment at the beginning of the catatonic state are essential for the best outcomes.

ECT and rTMS for Treating Depression

6 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, Fifth Ed., Text Revision (DSM-5-TR); 2022.Liu YW, Chang C, Chen TY, Chang HA, Kao YC, Tzeng NS. Refractory depression with catatonic features was remitted with administration of intravenous dopamine and consequent bupropion as maintenance treatment.Aust N Z J Psychiatry. 2016;50(6):599-599. doi:10.1177/0004867415616697Moskowitz AK.“Scared stiff”: Catatonia as an evolutionary-based fear response.Psychol Rev. 2004;111(4):984-1002. doi:10.1037/0033-295X.111.4.984Luchini F, Medda P, Mariani MG, Mauri M, Toni C, Perugi G.Electroconvulsive therapy in catatonic patients: Efficacy and predictors of response.WJP. 2015;5(2):182. doi:10.5498/wjp.v5.i2.182Bhati MT, Datto CJ, O’Reardon JP.Clinical manifestations, diagnosis, and empirical treatments for catatonia.Psychiatry (Edgmont). 2007;4(3):46-52.Sienaert P, Dhossche DM, Vancampfort D, De Hert M, Gazdag G.A clinical review of the treatment of catatonia.Front Psychiatry. 2014;5:181. doi:10.3389/fpsyt.2014.00181Additional ReadingDhossche DM, Goetz M, Gazdag G, Sienaert P.New DSM-5 category unspecified catatonia is a boost for pediatric catatonia: Review and case reports.Neuropsychiatry. 2013;3(4):401-410.Sienaert P, Dhossche DM, Gazdag G.Adult catatonia: Etiopathogenesis, diagnosis and treatment.Neuropsychiatry.2013;3(4):391-399.

6 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, Fifth Ed., Text Revision (DSM-5-TR); 2022.Liu YW, Chang C, Chen TY, Chang HA, Kao YC, Tzeng NS. Refractory depression with catatonic features was remitted with administration of intravenous dopamine and consequent bupropion as maintenance treatment.Aust N Z J Psychiatry. 2016;50(6):599-599. doi:10.1177/0004867415616697Moskowitz AK.“Scared stiff”: Catatonia as an evolutionary-based fear response.Psychol Rev. 2004;111(4):984-1002. doi:10.1037/0033-295X.111.4.984Luchini F, Medda P, Mariani MG, Mauri M, Toni C, Perugi G.Electroconvulsive therapy in catatonic patients: Efficacy and predictors of response.WJP. 2015;5(2):182. doi:10.5498/wjp.v5.i2.182Bhati MT, Datto CJ, O’Reardon JP.Clinical manifestations, diagnosis, and empirical treatments for catatonia.Psychiatry (Edgmont). 2007;4(3):46-52.Sienaert P, Dhossche DM, Vancampfort D, De Hert M, Gazdag G.A clinical review of the treatment of catatonia.Front Psychiatry. 2014;5:181. doi:10.3389/fpsyt.2014.00181Additional ReadingDhossche DM, Goetz M, Gazdag G, Sienaert P.New DSM-5 category unspecified catatonia is a boost for pediatric catatonia: Review and case reports.Neuropsychiatry. 2013;3(4):401-410.Sienaert P, Dhossche DM, Gazdag G.Adult catatonia: Etiopathogenesis, diagnosis and treatment.Neuropsychiatry.2013;3(4):391-399.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, Fifth Ed., Text Revision (DSM-5-TR); 2022.Liu YW, Chang C, Chen TY, Chang HA, Kao YC, Tzeng NS. Refractory depression with catatonic features was remitted with administration of intravenous dopamine and consequent bupropion as maintenance treatment.Aust N Z J Psychiatry. 2016;50(6):599-599. doi:10.1177/0004867415616697Moskowitz AK.“Scared stiff”: Catatonia as an evolutionary-based fear response.Psychol Rev. 2004;111(4):984-1002. doi:10.1037/0033-295X.111.4.984Luchini F, Medda P, Mariani MG, Mauri M, Toni C, Perugi G.Electroconvulsive therapy in catatonic patients: Efficacy and predictors of response.WJP. 2015;5(2):182. doi:10.5498/wjp.v5.i2.182Bhati MT, Datto CJ, O’Reardon JP.Clinical manifestations, diagnosis, and empirical treatments for catatonia.Psychiatry (Edgmont). 2007;4(3):46-52.Sienaert P, Dhossche DM, Vancampfort D, De Hert M, Gazdag G.A clinical review of the treatment of catatonia.Front Psychiatry. 2014;5:181. doi:10.3389/fpsyt.2014.00181

American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, Fifth Ed., Text Revision (DSM-5-TR); 2022.

Liu YW, Chang C, Chen TY, Chang HA, Kao YC, Tzeng NS. Refractory depression with catatonic features was remitted with administration of intravenous dopamine and consequent bupropion as maintenance treatment.Aust N Z J Psychiatry. 2016;50(6):599-599. doi:10.1177/0004867415616697

Moskowitz AK.“Scared stiff”: Catatonia as an evolutionary-based fear response.Psychol Rev. 2004;111(4):984-1002. doi:10.1037/0033-295X.111.4.984

Luchini F, Medda P, Mariani MG, Mauri M, Toni C, Perugi G.Electroconvulsive therapy in catatonic patients: Efficacy and predictors of response.WJP. 2015;5(2):182. doi:10.5498/wjp.v5.i2.182

Bhati MT, Datto CJ, O’Reardon JP.Clinical manifestations, diagnosis, and empirical treatments for catatonia.Psychiatry (Edgmont). 2007;4(3):46-52.

Sienaert P, Dhossche DM, Vancampfort D, De Hert M, Gazdag G.A clinical review of the treatment of catatonia.Front Psychiatry. 2014;5:181. doi:10.3389/fpsyt.2014.00181

Dhossche DM, Goetz M, Gazdag G, Sienaert P.New DSM-5 category unspecified catatonia is a boost for pediatric catatonia: Review and case reports.Neuropsychiatry. 2013;3(4):401-410.Sienaert P, Dhossche DM, Gazdag G.Adult catatonia: Etiopathogenesis, diagnosis and treatment.Neuropsychiatry.2013;3(4):391-399.

Dhossche DM, Goetz M, Gazdag G, Sienaert P.New DSM-5 category unspecified catatonia is a boost for pediatric catatonia: Review and case reports.Neuropsychiatry. 2013;3(4):401-410.

Sienaert P, Dhossche DM, Gazdag G.Adult catatonia: Etiopathogenesis, diagnosis and treatment.Neuropsychiatry.2013;3(4):391-399.

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