Depression with catatonic features shares symptoms of both major depression and catatonia but 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 thought of as a subtype of schizophrenia. Now experts consider it a syndrome that can occur on its own, due to medication, or at the same time as several mental and physical health conditions.
Catatonia co-occurs most often with mood disorders such as depression.
In the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text-revision (DSM-5-TR), this diagnosis is clinically called major depressive disorder with catatonic features.
MDD is a type of mood disorder that can affect the body and mind in many ways. Ongoing low mood, low energy, and loss of interest are some of the most common symptoms. Catatonia is a collection of symptoms affecting movement and behavior. Someone with catatonia may not speak (mutism), move (immobility), or appear rigid.
Depressive episodes last at least 2 weeks but can be ongoing. Catatonic episodes are usually considered “acute,” meaning they last just hours or days. But in some cases, catatonia can become chronic, lasting weeks to years.
It’s still not completely clear what causes catatonia.
The same neurotransmitters are thought to play a role in mood disorders.
A combination of genetics, the environment, and chemicals all affect someone’s chances of developing depression. So it’s likely not one single cause but a combination of several that leads someone to develop depression with catatonia.
Research from 2018 also suggests that increased age may be a contributing factor to developing catatonia in depression.
People with catatonic depression experience symptoms of both major depressive disorder and catatonia.
According to 2018 research, cognitive symptoms and trouble functioning in daily life may occur more in people with catatonic depression versus depression without catatonia.
Major depressive disorder
Depression can look slightly different from person to person, but symptoms include:
- feelings of sadness, hopelessness, or worthlessness
- less interest in things you once enjoyed
- difficulty concentrating or doing daily activities
- lack of energy and tiredness
- sleep or appetite changes
- physical symptoms such as body aches
- thoughts of self-harm or suicide
The DSM-5 lists just 12 possible symptoms of catatonia, but researchers have listed up to 40 symptoms, meaning it may look very different from person to person. Catatonia may continue to evolve or change over time.
Immobility and mutism are considered the most common symptoms of catatonia, affecting
- 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 dulled. They may seem unable to connect with the outside world.
- Posturing and catalepsy: Posturing is when someone purposely adopts and maintains a position for long periods of time. Catalepsy is a more severe type of posturing where the posturing occurs passively, not on purpose. In both types, postures are described as being “held against gravity,” meaning it’s a position you wouldn’t typically hold for so long.
- Waxy flexibility: In waxy flexibility, when someone manipulates a body part (e.g., moving your arm above your head), you’ll slightly resist but then remain in that position even after being told to relax.
- Negativism (aka gegenhalten): Someone with negativism won’t respond to or directly oppose instructions or stimuli from their environment.
- Agitation: Agitation isn’t affected by your external environment.
- Echolalia and echopraxia: Both these symptoms involve imitating other people. Echolalia is when you repeat words spoken by someone else, while echopraxia is when you mimic their movements.
- Stereotypies: These are frequent and repetitive movements that don’t seem to have a goal or purpose. An example of this would be rocking your body back and forth.
- Mannerism: In this symptom, you may do odd or exaggerated actions instead of typical ones. One example of this is hopping when you would normally walk.
People in catatonic episodes could appear rigid, grimace, withdraw, or refuse to eat. Some also experience symptoms of psychosis, which can confuse diagnoses.
Diagnosing catatonic depression will likely start with a thorough mental health exam, though it could involve aspects of a physical exam and blood tests.
To diagnose a major depressive episode, a healthcare or mental health professional may:
- discuss your symptoms, medical history, and family history with you
- ask you to take a depression screening
- request lab tests to see if anything else could be causing your symptoms
To diagnose catatonia, they may:
- discuss your symptoms, medical history, and family history with you
- observe and interview you for noticeable 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:
- responses to light and sound
- pain reactions
To specifically look for signs of catatonia, the evaluator might:
- observe you for abnormal movements and speech
- move your arm while telling you to keep your arm loose
- extend your hand for a handshake, but tell you “Do not shake my hand”
- check your grasp reflex
- exaggerate their own movements to see if you will copy their movements
Catatonia is considered highly treatable when diagnosed correctly. That’s why it’s crucial to seek treatment quickly and get second opinions if you don’t think the diagnosis was 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 start you on treatments for both depression and catatonia at the same time.
The first-line treatment for catatonia is the benzodiazpeine lorazepam (Ativan). You may be given the benzodiazepine intravenously (IV), in an injection, or in a pill form.
Some people with severe episodes of catatonia aren’t diagnosed until they’re in the hospital for another medical issue (e.g., infection or malnutrition) or in psychiatric in-patient units. In this case, you may be started on IV lorazepam and then given a different version for at-home use.
For depression, the go-to is a combination of antidepressants and psychotherapy. Other treatment options might include:
- transcranial magnetic stimulation (TMS)
- muscle relaxers
- mood stabilizers
Electroconvulsive therapy (ECT) has been proven effective for treating both catatonia and depression, especially when one or both are severe. Someone with catatonic depression may need more ECT sessions than someone with depression without catatonia.
Depending on a person’s symptoms, other ways of treating catatonia and its complications may involve:
- nutritional therapy
- prophylaxis for deep vein thrombosis
Catatonic episodes on their own can lead to very serious complications if left untreated. Someone with catatonic depression may experience additional challenges that come from their depression symptoms.
Since catatonia can affect a person’s mobility and whether they’re able to eat or drink, it can have widespread effects.
Untreated catatonia can sometimes lead to:
- pneumonia or other infections
- pressure ulcers (aka bed sores)
- muscle contractures, a shortening of muscles due to lack of movement
- deep vein thrombosis
- pulmonary embolism
Self-harm and suicidal thoughts may also come up for people with both catatonia and depression.
Antipsychotics are not recommended for people who have catatonia, as these have been associated with a high chance of developing neuroleptic malignant syndrome.
But can you die from catatonia?
Catatonia is highly treatable, but the symptoms can lead to severe complications, especially if you develop a severe form of catatonia called malignant catatonia.
For instance, someone who becomes malnourished may need to be put on a feeding tube. Or someone severely dehydrated may need IV hydration.
Still, all severe complications can be treated. The earlier treatment happens, the better the outcome.
If your loved one is living with depression with catatonia, how you care for them will greatly depend on their condition severity.
If you believe they’re showing symptoms of catatonic depression, you can help them seek professional care or take them to an emergency room.
If they had to be hospitalized for catatonic depression or its complications, aftercare will depend on the complication.
You may need to:
- help them with daily activities such as making sure they eat and drink
- ensure they take their medications daily
- assist them with moving, repositioning, and range of motion
- go with them to medical appointments
- create a plan with them and their care team to know what to do if symptoms worsen
While depression with catatonia is highly treatable, if diagnoses are delayed, severe 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 extra help, you can check out Psych Central’s guide to finding mental health support.