Catatonic depression
Catatonic depression is characterized as a spectrum of mood disorders and is distinguished by the co-occurrence of catatonia and major depressive disorder. Catatonic symptoms involve a variety of motor abnormalities and behavioral disturbances, such as stupor, immobility, mutism, negativism, posturing, rigidity, and repetitive or purposeless movements. Individuals suffering from catatonic depression frequently demonstrate a significant decline in their capacity to engage in voluntary behaviors and communicate effectively. These symptoms can significantly impair daily functioning and pose challenges in their personal and professional lives.
The exact cause of catatonic depression is not fully understood. However, it is believed to arise from a complex interplay of genetic, biochemical, and environmental factors. Some research suggests that disturbances in neurotransmitters like dopamine and gamma-aminobutyric acid may contribute to the development of catatonic symptoms. Furthermore, stressful life events, trauma, and certain medical disorders can raise the risk of developing this condition. Diagnosing catatonic depression requires a comprehensive evaluation by a qualified mental health professional. The Diagnostic and Statistical Manual of Mental Disorders has specific criteria for diagnosing catatonic symptoms associated with depression.
Catatonic depression is often treated using a multimodal approach. Antidepressants, mood stabilizers, and antipsychotics may be prescribed to manage depression symptoms and underlying neurotransmitter imbalances. Electroconvulsive therapy has also shown effectiveness in treating catatonic depression, particularly in cases where immediate intervention is required if other therapies have been unsuccessful. Individuals can benefit from supportive psychotherapy, cognitive-behavioral therapy, and psychosocial therapies to cope with symptoms and create management strategies for their illness. Catatonic depression is a debilitating and chronic condition that requires early intervention for optimal treatment. Individuals suffering from catatonic depression can benefit from appropriate treatment and support, resulting in symptom reduction and an improved overall quality of life. Seeking expert help and support is critical to ensuring the patient's accurate diagnosis and treatment.
Signs and symptoms
Catatonic depression is a complex psychiatric condition which involves both major depressive disorder and catatonia. Catatonic depression is characterised by a mix of symptoms and indications that overlap with major depressive disorder and catatonia.Stupor and mutism are the two most common symptoms. Although symptoms of catatonic depression can vary by individual, common signs of catatonia include grimacing, negativism, posturing, rigidity, and waxy flexibility.
Major depressive symptoms are also experienced by a person suffering from catatonic depression. These symptoms can include hopelessness, irritability, a loss of interest in or enjoyment from normal activities, sleep disturbances, exhaustion, anxiety, psychomotor retardation, feelings of worthlessness, difficulty concentrating, remembering things, and suicidal thoughts.
Physiological mechanism
The pathophysiology of catatonic depression is not currently well understood and mainly shrouded in mystery, but researchers have suggested possible pathophysiology explaining the major depressive disorder coupled with catatonic features.Reduced gamma-aminobutyric acid (GABA) activity
activation in the right lateral orbitofrontal and right posterior parietal cortex is suggested to be a plausible cause of catatonia syndrome dysfunction, which helps explain the motor and affective symptoms seen in catatonic individuals. Reduced GABA-A receptor density is found on imaging in cortical regions such as the left sensorimotor cortex, which suggests malfunctioning GABA-A signalling in catatonia.Dopamine dysfunction
There is some evidence that blockage of dopamine D2 receptor has led to reduced risk of exacerbating catatonia. This can be seen in neuroleptic malignant syndrome, which has similar symptoms to catatonia.An alternative idea suggests that the mesostriatal and mesocorticolimbic systems, and the hypothalamus need to maintain a balance between GABA-A and dopamine.
Glutamate dysfunction
anomalies have been observed in the basal ganglia as such excitatory glutamatergic N-methyl-D-aspartate receptors within this brain region appear to be associated with catatonia. Catatonic symptoms are thought to be caused by glutamate hyperactivity.There is a high correlation between catatonia and NMDAR encephalitis.
Abnormalities of the brain and brainstem pathway
The disruption of the following three motor pathways is hypothesised to be associated with catatonia.The first pathway involves the primary motor cortex, putamen, internal and external palladium and thalamus.
The second pathway runs between the M1, thalamus, cerebellum, and pontine nuclei.
The third pathway is composed of the M1, supplementary motor area, posterior parietal cortex, and medial prefrontal cortex.
It has been shown that individuals with catatonia have more blood flow to the M1 and SMA than those without catatonia. This implies a relation between catatonic depression and elevated neuronal activity in the M1 and SMA.
Autoimmune disorders
Catatonia is also associated with autoimmune encephalopathies that involves anti-neuronal antibodies. These antibodies become internalised within neurones and cause its dysfunction, leading to catatonic symptoms.Causes
Genetic susceptibility of an individual has been extensively supported in the case of major depressive disorders. In 2023, the genome-wide association studies have identified 178 genetic risk loci with more than 200 candidate genes. Based on the stress diathesis theory, people with a family history of mood disorder are more prone to developing depression due to stressful life events. However, major depressive disorder is not entirely dependent on genetics and is influenced by other factors.Research has indicated that there is a 27% chance of a patient developing catatonic symptoms if a first-degree relative has the disorder. Catatonia is also highly heritable. One gene linked to the heredity of catatonia is CNP, which codes for the enzyme cyclic nucleotide phosphodiesterase, which is necessary for myelination and oligodendrocyte function. Depletion of this gene causes the affected mice to develop catatonic depression.
Environmental factors
and immense stress are well-documented factors of major depressive disorders. Early life trauma is strongly correlated with the onset of mood disorder such as depression as well as the severity and duration of the malady.However, people with such experience may or may not develop depression while those without impactful life events may also develop major depressive disorder. This could be explained by the gene-environment interaction which influences the impact of life events on the development of a disease. A functional polymorphism of the promoter region of the serotonin transporter gene was found to moderate the influence of stressful life events on depression.