Melancholic and Catatonic Depression – Causes, Risk Factors, Symptoms, Treatment

Melancholic Depression is basically a sub type of Clinical Depression. It is regarded as a severe form of depression that is more common in women than men.

It is characterised by lack of interest of individual in activities that were once pleasurable. Also, individuals become slower in response to the temporary positive life events.

Causes of Melancholic Depression

Melancholia Depression is supposed to be caused due to biological factors. It is believed to be genetically inherited in the offspring from their parents.

Common Risk Factors

  • Stressful situations excluding life changing events
  • Individuals who suffer from bipolar depression I
  • Individuals who suffer from bipolar depression II
  • Individuals with psychotic features
  • Elderly patients who have dementia

Symptoms of Melancholic Depression

  • Anhedonia
  • Severe weight loss,
  • Psychomotor agitation
  • Psychomotor retardation
  • Insomnia with early morning awakenings
  • Feeling of guilt or worthlessness
  • Diurnal variation with worse symptoms in the morning hours

Treatment of melancholic Depression

  • Antidepressants
  • Electroconvulsive therapy
  • Supportive psychotherapy
  • Deeper psychotherapy

Catatonic Depression

Catatonic Depression is basically a sub type of Clinical Depression. It is characterised by state of neurogenic motor immobility and behavioural abnormality expressed in form of Stupor.

Diagnostic criteria for Catatonic Depression

As per DSM-IV guidelines, a patient with catatonic depression must have at least two of the following signs.

  • Motor immobility including waxy flexibility or stupor (as evidenced by catalepsy)
  • Excessive motor activity
  • Extreme negativism (motiveless resistance to all instructions)
  • Maintenance of a rigid posture
  • Consistent posturing, stereotyped movements
  • Prominent mannerisms or grimacing
  • Echolalia

Symptoms of Catatonic Depression

  • Excessive Movement (Purposeless)
  • High resistance to suggestions
  • Loss of voluntary movement
  • Inability to react to one’s environment
  • Inappropriate voluntary movements
  • Involuntarily repeating some words meaninglessly
  • Extreme loss of motor skills or hyperactive motor activity
  • Holding rigid poses for hours
  • Stereotyped and repetitive movements
  • Waxy flexibility
  • Meaningless phrases

If not treated, patients with catatonic excitement may get exhausted. The catatonic depression may manifest itself in form of following syndromes.

  • Kahlbaum syndrome (retarded catatonia)
  • Malignant catatonia (neuroleptic malignant syndrome)
  • Excited forms (delirious mania)
  • Autism spectrum disorders

Treatment of Catatonic Depression

The treatment of Catatonic depression is done by experienced psychiatrist after careful and thorough evaluation.

Psychiatrist may recommend various anti-depressants and other therapies like ECT for treating the catatonic state.

Antidepressants used

  • Benzodiazepines are commonly prescribed in higher doses during initial stages of treatment.
  • Intramuscular lorazepam (1-2 mg) produces marked improvement in half an hour
  • Zolpidem is also used in diagnosis

Other Therapies

  • Electroconvulsive therapy (ECT) is very effective treatment for catatonic depression that targets the underlying causes.
  • Antipsychotics are also used however they require extreme caution as they can lead to worsening of symptoms and cause serious adverse effects
  • NMDA antagonists such as amantadine or memantine are effective against benzodiazepine resistant catatonia
  • Topiramate is also used for treating resistant catatonia.