CATATONIC DEPRESSION(A guide)

In this brief guide, we will discuss what catatonic depression, its symptoms, causes, and treatments.

What is Catatonic Depression?

Catatonic depression is a type of depression that is characterized by not speaking and not moving for an extended period.

Catatonia is considered a subcategory for different mental illnesses, such as depression, schizophrenia, personality disorders, mood disorders, and others.

What is Catatonia?

Catatonia is a pathology that combines more than twenty symptoms, some of which are expressed by non-specific manifestations.

The core clinical manifestation of the disease is motor impairment. Catatonia disease consists of catatonic arousal and stupor.

Karl Ludwig Kahlbaum first described the term “catatonia” in 1874.

Earlier in the twentieth century, catatonia was considered only a subtype of schizophrenia.

Today, more and more studies prove that the pathology in question is a separate syndrome, often associated with affective and other disorders of mental activity, ailments of somatic and neurological nature, as well as poisoning.

The Forms of Catatonia

Catatonic agitation has two forms: pathetic and impulsive.

The pathetic form of catatonic agitation is characterized by a phased development, restrained by motor and moderate speech arousal.

The patient’s speech contains much pathos; sometimes, echolalia can be observed.

The mood of the patient is elevated, while it has the character of exaltation and not hyperthymia.

Besides, causeless laughter may occur periodically. With the escalation of symptoms, there are traits of hebephrenia (a form of schizophrenia, manifested in childhood, foolishness, eccentricity, ridiculous antics).

This behavior is called hebefrenocatonic agitation. Impulsive actions are also possible. In this case, a disorder of consciousness does not occur.

The impulsive form of catatonic agitation manifests itself acutely and is characterized by swift, often cruel, destructive actions.

Often, such actions of patients are socially dangerous. Moreover, the speech of patients consists of separate phrases.

Echopraxia, echolalia, perseveration are inherent in individuals at this stage of catatonia.

With maximum severity of the considered form of catatonic excitation, movements are characterized by randomness, intensity, sweeping, and irregularity.

Patients at this stage are speechless and prone to self-harm.

Mechanism of the development of catatonia

Although the mechanism for the development of catatonia is not precisely known, there are many hypotheses:

1. “Modulation from top to bottom” in the basal ganglia due to a deficiency in the GABA cortex may underlie motor symptoms of catatonia. This hypothesis explains the pronounced therapeutic effect of benzodiazepines, which increase the activity of GABA. It is also believed that catatonia is based on the increased activity of glutamate.

1. According to another hypothesis, catatonia is due to a sudden and massive blockade of dopamine. This assumption explains why antipsychotics that block dopamine, most often do not bring benefits in catatonia and may lead to a worsening of the condition.

1. Catatonia resulting from the abolition of clozapine is due, allegedly, to the resumption of increased activity of the cholinergic and serotonergic systems after discontinuation of this drug.

1. In chronic catatonia with visible speech impairment, positron emission tomography revealed bilateral metabolic disorders in the thalamus and frontal lobes.

1. There is a hypothesis according to which catatonia can be understood as an evolutionary reaction of fear in herbivores when encountering carnivores: this reaction is now manifested in many severe mental or somatic diseases in which the catatonic stupor can be a typical reaction due to an “end state” to a feeling of imminent death.

Symptoms of Catatonic Depression

Below you can see some symptoms of catatonic depression:

• Weight loss or weight gain,
• Appetite changes,
• Insomnia,
• Loss of interest in activities,
• Difficulty in thinking, making decisions and concentrating,
• Agitation,
• Fatigue,
• Suicide thoughts,
• Restlessness or anxiety,
• Sadness,
• Catalepsy (а trans-like state),
• Echolalia (meaningless repetition of another person’s words),
• Experience of pain,
• Perseveration (stable reproduction of any emotion, phrase, activity),
• Mutism (inability or refusal to speak),
• Negativism (for example, feels hungry but refuses to eat),
• Stupor (a lack of mobility and speech),
• Posturing (remaining in the same posture for quite a long time)
• Echopraxia (mimicking the actions of surrounding people)
• Feelings of worthlessness,
• Feeling guilty and others.

Causes of Catatonic Depression

The leading causes of catatonic depression are:

• Irregular production of neurotransmitters (dopamine, gamma-aminobutyric acid, and others),
• Significant life changes,
• Additional medical conditions like ADHD, sleeping problems, or other disorders,
• Family history of mental health conditions.

Treatments for Catatonic Depression

Below are treatments for catatonic depression:

Benzodiazepines

Benzodiazepines are a class of psychoactive drugs with a hypnotic, sedative, anxiolytic, muscle relaxant, and anticonvulsant effects.

The action of benzodiazepines is associated with exposure to gamma-aminobutyric acid receptors.

These drugs increase the effect of the GABA neurotransmitter.

They are practical to use to relieve the symptoms of anxiety, insomnia, and muscle spasms.

Benzos are addictive, so they are used as a short-term treatment.

Electroconvulsive therapy

ECT or electroconvulsive therapy is the most effective treatment for catatonic depression.

It is also used for some other mental illnesses, such as major depression, schizophrenia, and bipolar disorder.

Electroconvulsive therapy assumes attachment of small electrodes to head, which sends electrical impulses to the brain, intentionally triggering a brief seizure. 

Repetitive transcranial magnetic stimulation

Repetitive transcranial magnetic stimulation or rTMS is used to treat catatonic depression by targeting and stimulating specific areas of the brain with a magnet.

N-methyl-D-aspartate

N-methyl-D-aspartate or NMDA can also be useful for the treatment of catatonic depression (according to some studies).

NMDA is an amino acid derivative that mimics the behavior of the glutamate neurotransmitter.

People suffering from catatonic depression require psychiatric care.

Recommended books and sources

1. Catatonia: A Clinician’s Guide to Diagnosis and Treatment
2. Managing Severe Depression
3. The Madness of Fear: A History of Catatonia
4. Lost Connections: Why You are Depressed and How to Find Hope
5. HFNE “Am I Healthy?”
6. HFNE “Signs of Depression”

Conclusion

In this brief guide, we discussed catatonic depression. So, catatonic depression is a type of depression that is characterized by not speaking and not moving for an extended period.

If you struggle with catatonic depression, you should not worry as there are some treatments for it; it can be treated by benzodiazepines, ECT, NMDA, or rTMS. 

To know more about catatonia and depression separately, you can use the recommended books and sources.

Please feel free to comment on the content or ask any questions in the comments section below.

References

1. What is catatonic depression?
2. What to know about catatonic depression?