Catatonic depression

A subtype of major depressive disorder characterized by catatonia

Catatonic depression is a subtype of major depressive disorder that is characterized by the presence of catatonia, a state of psycho-motor immobility and behavioral abnormality. This condition is marked by a significant reduction in voluntary movement and responsiveness to external stimuli, often accompanied by mutism, stupor, and negativism.

Symptoms

Catatonic depression presents with a combination of depressive symptoms and catatonic features. The primary symptoms include:

• Motor immobility: Patients may exhibit stupor or catalepsy, where they maintain a fixed posture for extended periods.
• Mutism: A lack of verbal response despite the ability to speak.
• Negativism: Resistance to instructions or attempts to be moved.
• Posturing: Voluntary assumption of inappropriate or bizarre postures.
• Echolalia: Repetition of another person's spoken words.
• Echopraxia: Imitation of another person's movements.

Catatonia following an attack of melancholia

Causes

The exact cause of catatonic depression is not fully understood, but it is believed to involve a combination of genetic, neurobiological, and environmental factors. Neurotransmitter imbalances, particularly involving gamma-aminobutyric acid (GABA), dopamine, and glutamate, are thought to play a significant role.

Gamma-aminobutyric acid structure

Dopamine structure

Activated NMDA receptor

Diagnosis

Diagnosis of catatonic depression is based on clinical assessment and the presence of characteristic symptoms. It is important to differentiate it from other psychiatric and medical conditions that can present with similar features, such as schizophrenia, bipolar disorder, and neurological disorders.

Treatment

Treatment of catatonic depression typically involves a combination of pharmacotherapy and supportive care. Benzodiazepines, such as lorazepam, are often used as first-line treatment due to their rapid onset of action in alleviating catatonic symptoms. In some cases, electroconvulsive therapy (ECT) may be considered, especially when there is a lack of response to medication.

Lorazepam boxes

Prognosis

The prognosis for individuals with catatonic depression varies. With appropriate treatment, many patients experience significant improvement in symptoms. However, the risk of recurrence is high, and ongoing management may be necessary to prevent future episodes.

Related pages

• Major depressive disorder
• Catatonia
• Bipolar disorder
• Schizophrenia