The failure to recognize catatonia in a timely fashion allows depressed, manic, and psychotic patients to remain ill for want of proper diagnosis and treatment. Clinicians offer their patients many medications and combinations, hoping that the next regimen will be effective, despite the experience that when the first choice of a drug treatment fails, additional therapy trials are unlikely to improve outcomes. Such tactics prolong illness and risk severe consequences.

Treatment failure can also occur when officially sanctioned treatment guidelines are at variance with clinical experience. For example, the American Psychiatric Association (APA) treatment guidelines for schizophrenia do not mention the catatonic subtype. This omission leads to the failure to comment on the need to avoid antipsychotic drugs, the benefits of the initial use of benzodiazepines, and the efficacy of ECT in these patients. In contrast, the APA guidelines for the treatment of depression and “bipolar” mood disorder recognize that catatonia may occur within depression and recommend that if “relief [from catatonia] is not immediately obtained by administrating barbiturates or benzodiazepines, the urgent provision of ECT should be considered.”

We are fortunate in our present skills to treat catatonia and in our ability to recognize its many variants. Once recognized, catatonia can be effectively and rapidly relieved.