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Catatonic Depression: Signs, Causes and Treatment

Katelyn Hagerty

Reviewed by Katelyn Hagerty, FNP

Written by Our Editorial Team

Published 12/05/2022

Updated 12/06/2022

There are many types of depression you may have heard of, including major depressive disorder (MDD) and persistent depressive disorder. One you may be a little less familiar with? Catatonic depression.

So, what is catatonic depression? The condition occurs when depression and catatonia are experienced simultaneously — but there’s a lot more to it.

Keep reading to learn how catatonic depression affects people, the common symptoms and how it’s treated.

What Is Catatonic Depression? 

Catatonic depression is when catatonia occurs comorbidly with depression.

You’re probably at least somewhat familiar with depression. If not, the quickest way to explain it is by saying it’s a mental health condition that adversely impacts how you feel and act.

As for catatonia? That’s something you may be less familiar with. Simply put, catatonic syndrome impacts your awareness of what’s going on around you. It does this by messing with how your brain works.

Common signs of catatonia include communication impairment, a lack of movement and other abnormal behaviors.

People most at risk of catatonia episodes are those with mental disorders. This includes mood disorders like depression and bipolar disorder, as well as schizophrenia, neurological issues and other medical conditions.

As for how common catatonia is, it’s thought to occur in up to 2 percent of people who receive psychiatric care. But that number jumps to 10 percent for those who receive inpatient psychiatric care.

Malignant Catatonia

In some severe cases, malignant catatonia (also called malignant syndrome) may occur. This is when catatonia leads to death.

It happens because of something called dysautonomia, when the autonomic nervous system stops working as it should. This can lead to a too-high body temperature, a fast heart rate, sweating and more. Though malignant catatonia isn’t always fatal, death isn’t an uncommon result.

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Causes of Catatonic Depression

Since catatonic depression comprises two separate conditions, you need to look at both to find the cause.

Experts suspect different forms of depression are caused by low levels of certain neurotransmitters, like serotonin and dopamine. These brain chemicals are vital for relaying information between neurons.

As for catatonia, no one fully understands what causes it. However, people with the following psychological conditions are more likely to experience it:

  • Bipolar disorder

  • Schizophrenia

  • Schizoaffective disorder

  • Major depressive disorder (or major depression)

A number of neurological and medical conditions are also thought to possibly cause catatonia. They include autism spectrum disorders, Down syndrome, encephalitis, epilepsy and stroke, among others.

Given all this, it’s possible to have depression and another condition that causes catatonia — which would lead to catatonic depression. But it’s also possible for depression to lead to catatonia on its own.

Signs of Catatonic Depression

When catatonic depression occurs, people will experience both signs and symptoms of depression and catatonia.

But first, it’s helpful to know what to be on the lookout for when it comes to depression. Generally, if you experience depressive symptoms for more than a few weeks, you may be diagnosed with depression.

Some of the more common signs of a depressive episode are:

  • Feelings of sadness, hopelessness or worthlessness

  • Pessimism

  • Irritability

  • Low energy

  • Restlessness

  • No longer wanting to engage in social activities

  • Appetite changes, weight gain or weight loss

  • A decrease in libido

  • Trouble sleeping

If you’re dealing with catatonic depression, you’ll have some of the above symptoms but will also experience signs of catatonia.

Catatonic symptoms include: 

  • Catalepsy (holding a pose you’re placed in) 

  • Agitation

  • Echolalia (echoing sounds others make)

  • Echopraxia (mimicking someone else’s movements) 

  • Stiff or tense facial muscles or a grimace-like facial expression

  • Mutism (not talking) 

  • Not reacting to what’s going on around you (also called negativism) 

  • Repetitive movements that don’t have a purpose (also called stereotypy) 

  • Waxy flexibility or “locked-in syndrome” (not allowing someone to change your position)

Many signs of catatonia are hard to notice on your own. After all, if you’re in a catatonic state, you may not be super aware of yourself. Instead, a healthcare professional may notice these catatonic symptoms and diagnose you.

Treatment for Catatonic Depression

If someone goes into a catatonic state, it’s important to treat it first. Once catatonic symptoms are addressed, you’ll have more freedom to treat your depression.

In other words, you may need to treat catatonic depression in two parts: first the catatonia, then the depression.

Treating Catatonia

There are a few treatment options for the symptoms of catatonia.

Benzodiazepines can be a very effective medication prescribed to treat catatonia. In fact, up to 90 percent of people with catatonia who use this type of medication notice an improvement in catatonia symptoms.

Lorazepam (a type of benzodiazepine) is the most common medication used. It can be administered through an intravenous line, an injection or in pill form.

Electroconvulsive therapy (ECT) is another option. A mild electrical current is run through the brain to cause a minor seizure. This is often done under general anesthesia, so catatonic patients don’t even know it’s happening. ECT is commonly used for people with malignant syndrome, and it can save lives.

Once catatonia is handled, you can then focus on the depression aspect of catatonic depression.

Treating Depression

If you’re no longer catatonic but still dealing with moderate or severe depression, therapy and medication can be good solutions. Often, people will engage in both of these treatments.

It’s thought that cognitive behavioral therapy (CBT) can alleviate depression. The goal of CBT is to look at patterns that make your depression worse and come up with ways to stop these things.

Antidepressants are another option. Common types include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants.

However, if you’re still on benzodiazepines, you may not be put on an antidepressant.

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Recognizing Catatonic Depression

Catatonic depression is when someone has both depression and catatonia. 

Catatonia impacts your awareness of the world around you. People with certain mental disorders and mood disorders are more prone to catatonia, including depression and bipolar disorder.

Being in a prone position for a period of time, mutism and being unaware of what’s happening around you are all catatonia symptoms.

As noted, if you have catatonic depression, it’s important to seek treatment for catatonia first. Benzodiazepine medications and electroconvulsive therapy are both shown to be effective treatments for catatonia.

To learn more about catatonic depression, schedule an online consultation with a mental health professional.

7 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

  1. What is Depression? American Psychiatric Association. Retrieved from https://www.psychiatry.org/patients-families/depression/what-is-depression
  2. Catatonia. Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/23503-catatonia
  3. Hyman, S.E. (2005, March 8). Neurotransmitters. Current Biology. 15 (5), PR154-R158. Retrieved from https://www.cell.com/current-biology/comments/S0960-9822(05)00208-3
  4. Depression. National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/topics/depression
  5. Gautam, M., Tripathi, A., Deshmukh, D., Gaur, M., (2020). Cognitive Behavioral Therapy for Depression. Indian Journal of Psychiatry. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001356/
  6. What Meds Treat Depression? Mental Health America. Retrieved from https://screening.mhanational.org/content/what-meds-treat-depression/
  7. Guy-Evans, O. Serotonin vs. Dopamine: What Are the Differences? Simply Psychology. 2021. Retrieved from https://www.simplypsychology.org/serotonin-vs-dopamine.html

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Katelyn Hagerty, FNP
Katelyn Hagerty, FNP

Kate Hagerty is a board-certified Family Nurse Practitioner with over a decade of healthcare experience. She has worked in critical care, community health, and as a retail health provider.

She received her undergraduate degree in nursing from the University of Delaware and her master's degree from Thomas Jefferson University. You can find Katelyn on Doximity for more information.

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