For Nicholas Yarbrough, depression started making its presence felt subtly at first, and then all at once. He was 12 years old when he found himself withdrawing from everything he liked doing. He would isolate himself, spending most of his time playing games on his computer, reading or watching television. “At the time, I think that everyone very understandably wrote it off as just normal late-childhood sullenness,” Yarbrough recalled. “But looking back, it is clear that this was my depression making itself known.”
In school, the now-31-year-old writer from Washington, D.C. would find himself merely going through the motions. “Nothing that I did actually felt like I had accomplished anything, so I largely didn’t try,” he told Re:Set. By the time he was in college, he realized he needed to find ways to get through academic pressure somehow. “I excelled [in college] and while my symptoms didn’t improve, things were at least going relatively well.” However, his symptoms got worse in the winter of 2010 and he found himself crashing. Yarbrough spent a lot of time on the floor, barely eating or sleeping and spoke with a lot of difficulty. Whenever he did move, he could only make certain repetitive movements. At one point, he lost almost 25 pounds over three weeks. “I stayed like that for the better part of a month, but I’m mostly missing that month,” he reflected. “The parts that I do remember just sort of bleed into one another. The whole experience is just…a gray smear in my memory.”
“The parts that I do remember just sort of bleed into one another.”
Yarbrough had actually experienced acute symptoms of catatonic depression, a condition characterized by immobility, being unresponsive to external interactions and staying in bed for an extended period of time among others.
For someone with catatonic depression, simple everyday tasks such as getting out of bed can feel impossible. “Catatonia basically means when a person is immobile or [unresponsive],” Dr. Sheryl John Senthilnathan, a psychiatrist from Mumbai, India told Re:Set. “When a patient is completely immobile and not responsive, there is no way that we [psychiatrists] can develop a rapport with [them],” she said, explaining why it can be tricky to treat catatonic depression.
For Nicholas Yarbrough, a writer, receiving a diagnosis was a major breakthrough. Photo courtesy: Nicholas Yarbrough.
Medical professionals often have to turn to patients’ family members and close friends to understand the condition and family history better to form a proper diagnosis. Catatonic depression differs from other types of depression such as seasonal affective disorder, persistent depressive disorder and perinatal depression because it is strongly characterized by a person remaining motionless and not being able to engage with their surroundings. They’re likely to remain unusually still and not react to what’s happening around them.
Senthilnathan added that she’s often seen symptoms of catatonia in patients with other disorders such as schizophrenia and bipolar disorder. “Catatonia often appears as one of the primary symptoms in these illnesses, making it necessary to get a clear diagnosis as soon as possible to decide on the course of treatment”, she pointed out.
Currently, as per The Schizophrenia Bulletin, the general prevalence rate of the symptoms of catatonia among hospitalized patients in psychiatric wards is believed to be approximately 10%. Different types of catatonia have been recognized by medical professionals including periodic catatonia, retarded catatonia, delirious mania and more, which are characterized by different symptoms and seen across several mental illnesses.
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For Anita Link, 46, an animal veterinarian and a writer based in Brisbane, Australia, symptoms of depression hit after she had her first baby at 32. She initially experienced a psychotic episode five days after the delivery, and dealt with symptoms of catatonic depression about eight weeks later. “Since then, I have experienced severe episodes of mania, psychosis or depression every two to three years. These symptoms were diagnosed as Bipolar 1 disorder,” Link told Re:Set. She wrote about catatonic depression in her blog, describing it as a malignant type of cancer that spreads rapidly. “My limbs fill with concrete. The electrical connections between brain and muscle fail often. My body rejects food. The physical motion of eating is overwhelmingly difficult. My taste buds interpret everything I put in my mouth as sawdust,” she wrote. “My brain shuts down every function except suffering. The sort of suffering I imagine is like waking up on the operating table in the middle of open heart surgery, chest cracked open, and unable to tell anyone I’m awake because I am paralyzed. To look at me, no one could imagine who I am, because I am a shell. I can barely move or talk. I am approaching a vegetative state [when symptoms of catatonic depression set in] but I am in acute mental pain.”
Anita Link, an animal veterinarian and writer, experienced her first symptoms after the birth of her first child. Photo courtesy: Anita Link
Treating catatonic depression can be incredibly challenging because of a patient’s unresponsiveness to their surroundings and is done on a case-by-case basis, according to Senthilnathan. “Catatonic depression…because it is [one of the] most severe forms of depression…it will be treatment resistant [in most cases],” she said, adding that it is important to examine underlying neurological issues and rule out related illnesses such as schizophrenia and bipolar disorder because the treatment would vary in each case. It often requires carefully examining a patient’s case history and support from a psychiatrist.
“I didn’t have the wherewithal to force myself to eat most days.”
Getting psychiatric help was an important milestone for Yarbrough. “I was at the point where I was going to either voluntarily get help, be involuntarily hospitalized, or, to be frank, die. It had gone well beyond the point of ‘only’ being miserable, and I was actively and visibly physically deteriorating,” he shared. “I didn’t have the wherewithal to force myself to eat most days and I was literally wasting away.”
Getting an urgent appointment and receiving a diagnosis was one of the best moments of his life, according to Yarbrough. “I had sort of always suspected that something wasn’t quite right, and learning that my problems weren’t because I was lazy or a failure or a result of some other deeply personal moral failing but rather because of an actual illness and that there were treatment options available was enormously liberating,” he said. The right kind of medication has kept his symptoms at bay and helped him rebuild his life. Link too received swift medical attention and regularly sees her psychiatrist and psychologist while taking prescribed medication under the supervision of her doctors. “Thanks to a rapid early diagnosis and appropriate management, I have good insight into my symptoms and always seek help quickly,” she said. “I am very proactive about my mental health care.”
Link wants more people to be aware of catatonic depression and what it can feel like. “I believe most people are not aware [that] catatonic depression exists…If they are [aware, then they don’t know] that it is distinct from depression,” she admitted. “My experience of catatonic depression felt very biological. It went way beyond feeling sad or even hopeless and suicidal. My body felt as though it had shut down.”