What Is Catatonic Depression?

Overview
Catatonic depression is a subset of the diagnosis "major depression" and is characterized by severe disturbances in motor function. In the past century, the field of psychology has allowed its views concerning depression and its subsets to evolve from existential perspectives to cognitive-behavioral and biological understandings. Today, modern interventions draw upon a broad range of both mental and physical treatments.

History
Existentialist Soren Kierkegaard believed that persons failing to grasp a personal sense of freedom and responsibility were more susceptible to depression. Later, the behaviorist B.F. Skinner contended that depression stemmed from persons having an "external locus of control," meaning they learned to be helpless and vulnerable by modeling their environment. From this, the teachings of cognitive therapist Aaron Beck evolved. He asserted that both cognitions (thoughts) and the environment caused depression. More specifically, a person's negative mental perceptions of their environment generated a depressive cycle that reinforced their faulty beliefs. Modern research focuses on the biological components of depression by highlighting the influence imbalanced neurotransmitters such as serotonin, norepinephrine and dopamine have on mood disorders.

Types
According to the Encyclopedia of Mental Disorders, "Catatonic disorders are a group of symptoms characterized by disturbances in motor (muscular movement) behavior that may have either a psychological or a physiological basis." Catatonic depression is a subtype of the DSM-IV diagnosis "major depression." Other types of depression include atypical, melancholic, psychotic, postpartum and seasonal affective disorder (SAD). The main distinguishing feature of catatonic depression from the other subtypes is a significant disturbance in motor function.

Features
To make a diagnosis of catatonic depression, at least two of the following symptoms must be present: excessive purposeless motor activity, motoric immobility (cataleptic loss of mobility or stupor), extreme negativism with rigid posture or refusal to speak, echolalia/echopraxia (parroting other people's words or actions) and strange voluntary movements. Primarily, persons with catatonic depression remain motionless and may hold a position someone else places them into. Another prominent indicator is excessive activity that is performed without purpose or reason, such as rocking back and forth.

Prevention/Solution
The most effective form of psychotherapy for depression is Beck's cognitive-behavioral therapy, which seeks to break a person's negative perceptions about themselves, their world and their future. Following the Monoamine theory, most medicines prescribed for depression seek to increase levels of imbalanced neurotransmitters in the brain. Commonly prescribed antidepressants include selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs). In cases of extreme debilitating depression, psychiatrists may opt for the treatment of electroconvulsive therapy (ECT), wherein electrical current is passed through the patient, causing seizures that temporarily diminish depressive symptoms.

Theories/Speculation
A meta-analysis of bright light therapy by the American Psychiatric Association demonstrated that exposure to ultraviolet light diminishes depressive symptoms. Acupuncture was found to be as effective as medication, according to a 2004 Cochrane Review. Finally, a study by Duke University found that 30 minutes of brisk exercise three times a week helped to reduce depressive episodes. Nevertheless, more research into these areas is needed before psychologists will consider them viable forms of treatment.

Resources
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revised. Washington, D.C.: American Psychiatric Association, 2000.
http://www.dsmivtr.org/

Encyclopedia of Mental Disorders
http://www.minddisorders.com/index.html
Pfuhlmann, B., and G. Stober. "The Different Conceptions of Catatonia: Historical Overview and Critical Discussion." European Archives of Psychiatry and Clinical Neruoscience251 Supplement 1 (2001):14-7.
http://www.ncbi.nlm.nih.gov/pubmed/11776270