How Catatonic Depression Differs From Other Forms of Depression

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 fall into the category of "unspecified." Unspecified catatonia includes all cases in which there is no major psychotic, affective or medical disorder which can be diagnosed.

Catatonic depression is simply when catatonia occurs concurrently with depression.

Catatonia itself is not uncommon. Although reports vary, about 10 percent of psychiatric inpatients in western countries have been reported to show this condition. But it's rare for patients with major depressive disorder to have it. When it occurs with depression, it is generally within the context of bipolar disorder. The majority of all psychiatric patients with catatonia have bipolar disorder followed by schizophrenia.

While it is unknown exactly what causes catatonia, a number of theories have been put forth, including the following:

• Deficiency in gamma-aminobutyric acid (GABA)
• Dysregulation in glutamate
• Dysregulation in dopamine
• Abnormalities of metabolism in the thalamus and frontal lobes

Perhaps the most interesting theory, however, is one that suggests that catatonia may be due to an exaggerated primal fear response. It is possible, these scientists suggest, that our prehistoric ancestors, who had to frequently deal with predators, evolved the ability to remain very still for long periods of time in order to avoid detection by dangerous animals. Catatonia, they say, may be this ancient defense mechanism being triggered into action by strong feelings of fear.

Catatonia is a syndrome which includes many different signs and symptoms, some of which are fairly broad in nature. The following list describes some of the possible manifestations:

• Stupor - Perhaps the most prominent sign is stupor. Stupor is characterized by a lack of mobility and speech.
• Posturing - Persons with catatonia are able to remain in the same posture for quite considerable periods of time.
• Waxy flexibility - The clinician who is examining a catatonic patient is able to position the patient in what would normally be very uncomfortable poses which the patient will continue to maintain for a long period of time.
• Negativism - When someone examining a patient attempts to move one of the patient's body parts, he is met with resistance equal to the amount of strength that is being applied.
• Automatic obedience - The patient automatically obeys all instructions given by the examiner.
• Ambitendency - The patient alternates between cooperating with the examiner's instructions and resisting them.
• Psychological pillow - The patient lies down with his head a few inches above the bed, almost as if there is an invisible pillow resting under his head. This position can be maintained for an extended amount of time.

Benzodiazepines and electroconvulsive therapy (ECT) are the two main treatments for catatonia, although certain other treatments, such as some atypical antipsychotics, may also be utilized.

• Benzodiazepines - Benzodiazepines are the first-line choice for treating catatonia. They work by increasing the effects of the neurotransmitter GABA. This type of medication is also able to quickly provide relief for symptoms such as anxiety, sleeplessness, agitation and muscle spasms. About 70 percent of people with catatonia do well with a benzodiazepine called lorazepam.
• Electroconvulsive therapy - ECT is the most efficacious treatment available for catatonia.  It works for about 85 percent of patients. Benzodiazepines are generally tried first. The two therapies may be combined.

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

Dhossche, Dirk M. "New DSM-5 category ‘unspecified catatonia’ is a boost for pediatric catatonia: review and case reports."  Neuropsychiatry.  3.4 (2013) : 401-410.