It's rare, but catatonic depression does affect about 1 percent of the U.S. population. In extreme cases, a person experiencing catatonic depression may become speechless or motionless.

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Catatonia is the condition behind catatonic depression. It’s a seemingly bizarre condition in which people remain speechless and motionless or may become stuck making the same stereotypical and meaningless movements and sounds over and over for extended periods of time. Often, people in a catatonic state exhibit wax-mannequin-like flexibility, meaning they will submit to being moved in any position, such as holding their arms in the air, and remain that way.

Some who experience catatonia may robotically repeat the movements or words of others or contort their faces into strange grimaces. Still others in catatonic states may have rigid limbs and dramatically slowed down bodily functions, a condition known as catalepsy.

Causes of Catatonia and Catatonic Depression

There are many causes of catatonia. Most of these are medical. For instance, it can occur as a result of a drug overdose or a brain disorder related to such factors as infection or degenerative disease. In rare cases, catatonia also occurs in conjunction with a psychiatric disorder. It is most commonly seen in patients who are psychotic, meaning they have lost touch with reality and may be experiencing delusions or hallucinations.

Catatonia can also occur in association with depression, a condition known as catatonic depression. It’s not very common, however: Less than 1 percent of the population develops catatonic depression. When catatonia is seen in conjunction with depression, it is most often present in the depressive phase of people suffering from bipolar disorder.

The terms used to identify catatonic depression have changed recently. In the past, people with catatonia and depression were diagnosed as having catatonic depression. Today, however, catatonia is classified as a psychiatric diagnosis in and of itself. Someone experiencing both catatonia and depression would be diagnosed with “depression with catatonic features.”

Experts are not sure what causes catatonic depression. Possibilities include negative reactions to medication (or overdose), cognitive decline (particularly in older adults), or substantial imbalances in neurotransmitters in the brain. It is believed that the neurotransmitters most likely to be dysregulated in people with catatonic depression are dopamine, GABA, and glutamate.

There is also a theory that catatonia can sometimes be the body’s extreme reaction to the normal fight, flight, or freeze response. In the wild, animals respond to immediate danger by preparing to do battle (fight), running away (flight), or playing dead (freeze). It is possible that catatonia is a very intense “freeze” response in some people. This theory is backed up by the observation that catatonia sometimes occurs in people suffering from post-traumatic stress disorder (PTSD), since their response to danger cues is known to be overactive.

Catatonic Depression Symptoms

In addition to the features of catatonic described above, people with catatonic depression may also exhibit any of the following symptoms:

• Agitated, stereotypical movements: They may make the same movements over and over. These movements will seemingly have nothing to do with their environment or have any intent or meaning behind them.
• Automatic obedience: They may robotically follow any instructions given.
• Aversion: They may turn physically away from any attempt at communication or connection.
• Changes in cooperativeness: They may submit meekly to instructions and then suddenly become resistant.
• Changes in speech: Speech may be very slowed down and robotic-sounding.
• Loss of appetite: They often will refuse to eat or drink anything.
• Posturing: They may stay in the same position, even a very awkward one, for prolonged periods of time. People in catatonic states have been known to stay in the same position for months at a time.
• Psychological pillow: They may lie down with their head just above the bed, as if an invisible pillow were holding it up.
• Negativism: They may respond to all attempts to be moved with the exact same degree of pressure or force as that being exerted on them.
• Slowed movement: They might be so slowed down that it takes an hour or more just to sit up in bed.
• Stupor: They may remain immobile and silent for long periods of time.

Treatment Options for Catatonic Depression

People suffering from catatonic depression require prompt treatment. The longer they remain in that state, the harder it can be to bring them out of it. Treatments include:

• Electroconvulsive therapy (ECT)
• The anti-anxiety and muscle relaxing medications known as benzodiazepines
• Antipsychotic medications

People who have experienced catatonia do not always come back to full functioning. They are also at risk for the rest of their lives that they will have another catatonic episode.