Management of Acute Onset Catatonia Postpartum in a Patient With a History of Major Depressive Disorder With Psychotic Features: A Case Report

Catatonia is a rare but potentially life-threatening neuropsychiatric syndrome characterized by a range of motor, behavioral, and affective abnormalities. Catatonia is broadly categorized into three clinical presentations: associated with a psychiatric disorder, secondary to a medical condition, or of unspecified origin. Postpartum catatonia remains poorly understood, particularly in cases where there is no active psychiatric or medical illness at the time of onset. Most documented cases occur in the context of severe peripartum mood or psychotic episodes, highlighting the unique nature of catatonia emerging independently in the postpartum period. In this case report, we present a 33-year-old woman with a known history of major depressive disorder with psychotic features who developed catatonia within 24 hours following childbirth. Notably, the patient exhibited no signs or symptoms of depression or psychosis during the pregnancy or at the time of catatonic onset. She denied experiencing any mood or psychotic symptoms leading up to delivery, and her presentation was not consistent with a relapse of her previous psychiatric condition. This case is notable for its unique context: catatonia emerging in the immediate postpartum period without concurrent psychiatric decompensation or identifiable medical triggers. It raises important clinical questions about whether postpartum physiological or hormonal changes alone may precipitate catatonia in vulnerable individuals, even in the absence of overt psychiatric illness. Our report underscores the importance of maintaining a high index of suspicion for catatonia in postpartum patients, including those without active psychiatric symptoms. Early recognition and treatment are critical for optimal outcomes. Furthermore, this case highlights the need for more research to better understand the spectrum of postpartum catatonia and to determine whether it may, in some instances, represent a distinct clinical entity separate from traditional psychiatric or medical frameworks.