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Depression with catatonic features shares the symptoms of major depression and catatonia, but the symptoms are manageable.

If you have both major depressive disorder (MDD) and symptoms of catatonia, you may be diagnosed with MDD with catatonic features – sometimes just called catatonic depression.

Historically, catatonia was considered a subtype of schizophrenia. Today, experts consider it a syndrome that can occur on its own, due to medications, or along with several mental and physical health conditions.

Catatonia most often coexists with mood disorders such as depression.

Catatonic depression occurs when a person has symptoms of both catatonia and major depressive disorder.

In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR), this diagnosis is clinically referred to as major depressive disorder with catatonic features.

MDD is a type of mood disorder that can affect the body and mind in several ways. A persistent bad mood, lack of energy and loss of interest are some of the most common symptoms. Catatonia is a collection of symptoms affecting movement and behavior. A person with catatonia may not speak (mutism), move (immobility), or appear rigid.

Depressive episodes last at least 2 weeks but may be continuous. Catatonic episodes are generally considered “acute,” meaning they only last a few hours or days. But in some cases, catatonia can become chronic and last for weeks or even years.

It is still unclear exactly what causes catatonia.

Researchers have hypothesized that the neurotransmitters gamma-aminobutyric acid (GABA), glutamate, serotonin, and dopamine all play a role in catatonia.

The same neurotransmitters are thought to play a role in mood disorders.

A combination of genetics, environment and chemicals all affect the risk of developing depression. It is therefore probably not a single cause but a combination of several that causes a person to develop depression with catatonia.

Research from 2018 also suggests that increasing age may be a contributing factor to the development of catatonia in depression.

People with catatonic depression experience both symptoms of major depressive disorder and catatonia.

According to research from 2018, cognitive symptoms and impaired functioning in daily life may occur more in people with catatonic depression than in people with depression without catatonia.

Major depressive disorder

Depression may look slightly different from person to person, but symptoms include:

  • feelings of sadness, hopelessness, or worthlessness
  • less interest in things you once loved
  • difficulty concentrating or doing daily activities
  • lack of energy and fatigue
  • irritability
  • sleep or appetite changes
  • physical symptoms such as body aches
  • thoughts of self-harm or suicide

A doctor may also want to rule out other types of depression, as well as bipolar disorder.

catatonia

The DSM-5 only lists 12 possible symptoms of catatonia, but researchers have listed up to 40 symptoms, which means it can look very different from person to person. Catatonia may continue to evolve or change over time.

Immobility and dumbness are considered the most common symptoms of catatonia, affecting up to 90% of people with the disease.

  • Immobility involves resistance to moving or being moved.
  • Mutism is defined as a refusal to speak or respond verbally.

Other symptoms of catatonia include:

  • Stupor: Stupor is a type of altered consciousness. People in a stupor may not move (immobility) and appear blunted. They may seem unable to connect with the outside world.
  • Posture and catalepsy: Posture it is when someone deliberately adopts and maintains a position for long periods of time. Catalepsy is a more severe type of posture where the posture occurs passively, not on purpose. In both types, the poses are described as being “held against gravity,” meaning it’s a position you wouldn’t typically hold for that long.
  • Waxy Flexibility: In waxy flexibility, when someone manipulates a body part (for example, moving your arm above your head), you will resist slightly but will stay in that position even after you’ve been told to relax .
  • Negativity (aka gegenhalten): A person with negativism will not directly respond or oppose instructions or stimuli from their environment.
  • Hustle: Agitation is unaffected by your external environment.
  • Echolalia and echopraxia: Both of these symptoms involve mimicking other people. Echolalia is when you repeat the words spoken by someone else, while echopraxia is when you imitate their movements.
  • Stereotypes: These are frequent, repetitive movements that seem to have no purpose or purpose. An example of this would be rocking your body back and forth.
  • Mannerism: In this symptom, you may do strange or exaggerated actions instead of the typical actions. An example of this is hopping when you would normally walk.

People in catatonic episodes may seem rigid, wince, withdraw, or refuse to eat. Some also show symptoms of psychosis, which can confound diagnoses.

The diagnosis of catatonic depression will likely begin with a thorough mental health examination, although it may involve aspects of a physical exam and blood tests.

To diagnose a major depressive episode, a medical or mental health professional may:

  • discuss your symptoms, medical history and family history with you
  • ask you to be screened for depression
  • request lab tests to see if something else could be causing your symptoms

To diagnose catatonia, they may:

  • discuss your symptoms, medical history and family history with you
  • observe and question you for visible signs of catatonia
  • check your vital signs frequently
  • request lab tests to check for underlying causes and complications
  • request an EEG or MRI to test for other neurological conditions
  • perform a neurological exam to assess things such as:
    • reflexes
    • responses to light and sound
    • painful reactions

To specifically look for signs of catatonia, the assessor can:

  • observing you for abnormal movements and speech
  • move your arm while telling yourself to keep your arm loose
  • reach out for a handshake, but say to yourself “don’t shake my hand”
  • check your grasp reflex
  • exaggerate their own moves to see if you will copy their moves

Catatonia is considered highly treatable when diagnosed correctly. That’s why it’s crucial to seek treatment quickly and get a second opinion if you think the diagnosis isn’t 100% accurate.

Treatment for catatonic depression will combine treatments for depression and catatonia.

Since catatonic episodes can lead to life-threatening complications, your doctors may focus on treating the catatonia first. But they may choose to have you start treatments for depression and catatonia at the same time.

The first-line treatment for catatonia is the benzodiazpeine lorazepam (Ativan). Benzodiazepine may be given to you intravenously (IV), by injection, or as a pill.

Some people with severe episodes of catatonia are not diagnosed until they are hospitalized for another medical condition (eg, infection or malnutrition) or in psychiatric inpatient units. In this case, you can start IV lorazepam and then give yourself a different version for home use.

For depression, the go-to is a combination of antidepressants and psychotherapy. Other treatment options may include:

Electroconvulsive therapy (ECT) has been shown to be effective in treating both catatonia and depression, especially when one or both are severe. A person suffering from catatonic depression may need more electroshock sessions than a person suffering from depression without catatonia.

Depending on a person’s symptoms, other ways to treat catatonia and its complications may involve:

  • nutritional therapy
  • hydration
  • deep vein thrombosis prophylaxis
  • hospitalization

Catatonic episodes alone can lead to very serious complications if left untreated. A person with catatonic depression may experience additional difficulties that stem from their symptoms of depression.

Since catatonia can affect a person’s mobility and ability to eat or drink, it can have widespread effects.

Untreated catatonia can sometimes lead to:

Self-harm and suicidal thoughts can also occur in people with both catatonia and depression.

Antipsychotics are not recommended for people with catatonia, as they have been associated with a high risk of developing neuroleptic malignant syndrome.

But can you die of catatonia?

Catatonia is highly treatable, but symptoms can lead to serious complications, especially if you develop a severe form of catatonia called malignant catatonia.

For example, a person who is malnourished may need to be put on a feeding tube. Or a severely dehydrated person may need IV hydration.

Yet, all serious complications can be treated. The earlier the treatment, the better the results.

If your loved one is suffering from depression with catatonia, how you care for them will greatly depend on the severity of their condition.

If you think he has symptoms of catatonic depression, you can help him see a professional or take him to the emergency room.

If they were to be hospitalized for catatonic depression or its complications, follow-up will depend on the complication.

You may need:

  • help them with daily activities, such as making sure they eat and drink
  • make sure they take their medication daily
  • help them move, reposition and range of motion
  • accompany them to medical appointments
  • create a plan with them and their care team for what to do if symptoms get worse

While depression with catatonia is highly treatable, if diagnoses are delayed, serious complications can occur.

If you or a loved one is living with catatonic depression, creating a care plan to manage the condition and prevent future complications can make a big difference.

If you need more help, you can check out Psych Central’s guide to finding mental health support.

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