What Is Catatonia? Catatonic State, Symptoms and Treatment

Catatonic means a person is awake but cannot move, speak or respond in the usual way. A catatonic state is the period when those changes are present: they may appear frozen, rigid, mute or withdrawn, or highly agitated and unable to settle.

What does catatonic mean?

Catatonic describes a serious change in how a person moves, speaks or responds. They may freeze, hold an unusual posture, go silent, or become highly agitated, while still awake. It is not a choice. Catatonia can appear with severe depression, bipolar disorder, psychosis or physical illness, and it needs urgent medical assessment.

Is catatonia an emergency?

Yes. Catatonia can be life-threatening. Call 999 or go to A&E if someone is not eating or drinking, cannot be roused, is rigid or immobile, very confused, severely agitated, psychotic, or at risk of harming themselves. Do not wait to see whether it passes. NHS guidance is to treat a mental health emergency like any other medical emergency: if someone is in danger, call 999 or go to A&E now.

If you need urgent help but it is not clearly an emergency, call 111. NICE treats severe catatonia as a condition that may need urgent hospital treatment, including when it is potentially life-threatening.

• Catatonic state: what you might see: Frozen, rigid, staring, little or no speech · What to do now: Call 999 or go to A&E. Stay with the person. Do not try to snap them out of it.
• Catatonic state: what you might see: Not eating or drinking, or cannot be roused · What to do now: Call 999 or go to A&E now. This can become life-threatening.
• Catatonic state: what you might see: Unusual postures, resistance when moved, repetitive movements · What to do now: Get urgent medical assessment. Keep the room calm and quiet.
• Catatonic state: what you might see: Severe agitation, pacing, or purposeless activity · What to do now: Call 999 or go to A&E if they cannot settle or may harm themselves.
• Catatonic state: what you might see: Unsure whether it is an emergency · What to do now: Call 111, or a GP or mental health team, and describe the signs.

When catatonia occurs together with a depressive illness, it is often called catatonic depression. The sections below cover what that looks like, why assessment matters, how it is treated, and how families can help.

What catatonic depression can look like

Catatonic depression involves low mood and emotional distress accompanied by significant changes in movement, speech, responsiveness, or behaviour. The presentation can shift, so someone who is immobile and silent one hour may become restless and agitated the next.

Common signs include:

• Minimal speech or complete mutism
• Marked immobility, stiffness, or holding a fixed posture for long periods
• Staring, with reduced or absent facial expression
• Repetitive movements, or resistance when someone tries to move them
• Agitation, pacing, or purposeless activity
• Poor self-care, or an inability to eat, drink, or complete daily tasks

Because some of these signs overlap with severe depression itself, catatonia is easy to miss. That is one of the reasons a proper clinical assessment is so important.

Why assessment matters

Catatonic symptoms can occur alongside severe depression, bipolar disorder, psychosis, trauma, neurological conditions, medication effects, substance use, and physical health problems. The same outward signs can have very different causes, and the right treatment depends on identifying the cause. Professional evaluation is essential before deciding how to respond.

Assessment also screens for the medical risks that can accompany catatonia, such as dehydration, not eating, blood clots from prolonged immobility, and complications that can become dangerous if untreated. The Royal College of Psychiatrists notes that untreated catatonia can lead to dehydration, malnutrition, pressure ulcers, infections and blood clots, and that these effects can sometimes lead to the person dying.

This is why catatonia is treated as a condition that needs prompt clinical attention rather than something to manage at home.

If you are worried that depression has become this severe, and it is not an emergency, speak to a doctor. That can be your GP, or one of ours: the Promis team includes a primary care physician and consultant psychiatrists (meet the team), and you can arrange an assessment directly.

Treatment for catatonic depression

Catatonia is treated medically, and many people respond well once it is recognised. Management may include urgent medical intervention, psychiatric assessment, medication, close monitoring, and treatment of the underlying depression.

The most common first-line treatment is a benzodiazepine, usually lorazepam, which can produce a rapid improvement and also helps confirm the diagnosis. The Royal College of Psychiatrists describes lorazepam as the usual first treatment for catatonia. Where catatonia is severe, persistent, or does not respond to medication, electroconvulsive therapy (ECT) may be used.

NICE recommends considering ECT for catatonia to achieve rapid, short-term improvement of severe symptoms after other treatment has not worked, or when the condition may be life-threatening. Throughout, the underlying depression or other condition is treated alongside the catatonia, and physical health is monitored closely.

Severe cases may require inpatient hospitalisation so that the person can be kept safe, supported with nutrition and fluids, and stabilised under supervision. Decisions about medication, ECT, and admission are made by the treating clinicians based on the individual's needs.

At Promis we provide formulation-led care across two inpatient clinics, in London and in Kent, with weekly psychiatric input as part of a multidisciplinary team. Promis is part of the same group as Cardinal Clinic, a consultant psychiatrist-led private psychiatric hospital in Windsor. If a psychiatric hospital admission is needed, our admissions team can talk you through an admission to Cardinal Clinic. Our own clinics can support longer-term recovery from the underlying depression once the person is stable. In an acute medical emergency of the kind described above, the right step is still urgent assessment through the NHS or emergency services first.

How families can respond

If you are with someone who may be in a catatonic state, the priority is safe, calm support while you get professional help. Keep the environment calm and quiet, reduce noise and stimulation, and stay with the person. Do not try to force them to move, eat, or speak, and do not attempt any technique to snap them out of it. Catatonia is a medical condition, not a behaviour that can be talked or pushed away.

Seek professional help immediately. Call 999 or go to A&E if the person cannot be roused, is not eating or drinking, is rigid or immobile, severely agitated, or at risk. If you are unsure how urgent it is, call 111 for advice, or contact their GP or mental health team.

When you reach a clinician, it helps to share as much detail as you can: when the symptoms started, what changed beforehand, any medications the person takes, whether they have been eating and drinking, and any history of depression, bipolar disorder, psychosis, or previous episodes. This information speeds up assessment and treatment.

Frequently asked questions

What does catatonic mean?

Catatonic means a person is awake but cannot move, speak or respond in the usual way. They may freeze, hold an unusual posture, go silent, or become highly agitated. It is a medical state, not a choice, and they cannot simply will themselves out of it.

How long does a catatonic state last?

There is no single timescale. A catatonic state may last hours, days or weeks, and it does not reliably pass on its own. The Royal College of Psychiatrists notes that once treatment begins, many people improve within hours or days, while others take weeks. Untreated catatonia can become medically dangerous, so the length of the state is a reason to get treatment, not a reason to wait.

Is catatonia the same as catatonic depression?

No. Catatonia is the syndrome of changed movement, speech and responsiveness. Catatonic depression is one setting in which that syndrome appears: catatonia together with a depressive illness. The same catatonic state can also occur with bipolar disorder, psychosis, or a physical illness.

What is catatonia?

Catatonia is a serious condition that affects movement, speech, and responsiveness. A person may be unable to move or speak normally, hold unusual postures, repeat movements, or stop responding to the people around them. It can occur with severe depression, bipolar disorder, psychosis, or a physical illness, and it needs urgent professional assessment.

What is a catatonic state?

A catatonic state is the period during which catatonic symptoms are present. Someone in a catatonic state may seem frozen, rigid, mute, or withdrawn, or at the other extreme may be intensely agitated and unable to settle. It is a medical state, not a choice, and the person cannot simply will themselves out of it.

What are the symptoms of catatonic depression?

Catatonic depression combines low mood with marked changes in movement and responsiveness. Signs include little or no speech, immobility or stiffness, staring with a blank expression, holding fixed postures, repetitive movements or resistance to being moved, agitation, and an inability to manage everyday tasks such as eating, drinking, or self-care.

How is catatonia treated?

Catatonia is treated medically. The usual first-line treatment is a benzodiazepine, typically lorazepam, which often brings rapid improvement. Electroconvulsive therapy (ECT) is used when catatonia is severe or does not respond to medication, in line with NICE guidance on ECT for catatonia. The underlying depression or other condition is treated at the same time, and physical health is monitored closely, sometimes in hospital.

How do you help someone in a catatonic state?

The most important step is to get urgent medical help. Call 999 or go to A&E if the person cannot be roused, is not eating or drinking, is rigid or immobile, very confused, severely agitated, or at risk. While you wait, keep the environment calm and quiet and stay with them, but do not try to force them to move or use any technique to snap them out of it. Catatonia needs professional treatment, not a do-it-yourself approach.

Getting help

If depression has become severe, or you are worried that someone you love is showing the signs described here, do not wait. In an emergency, call 999 or go to A&E. For urgent mental health advice that is not an emergency, call 111, or contact a GP or mental health team. You can also call Samaritans on 116 123. Online content is not a substitute for assessment or emergency care.

For confidential support around severe depression and recovery once someone is stable, you can contact us or arrange an assessment. If a psychiatric hospital admission is needed, our admissions team can talk you through an admission to Cardinal Clinic.

Contact Promis: London: 0207 581 8222 | Kent: 01304 841 700

Author and clinical reviewer: Robin Lefever, Managing Director & Therapist.