<h3>Introduction</h3> Background: Catatonia is a neuropsychiatric syndrome characterized by a variety of motor, behavioral, emotional, and autonomic abnormalities. It can be caused by general medical, neurological, or psychiatric disorders, as well as by medications and drugs of abuse . Although there is a high prevalence of catatonia in the geriatric population, there is less data available when compared to other age group. . Among psychiatric disorders, depression is commonly associated with catatonia. And in most instances, there is a known history of depression reported in these catatonic patients. We are presenting a unique case in which an older adult presented with catatonia as the initial presentation of depression. We will then present a review of the literature of catatonia in older adults. Case: Mr. B is a 75 year old man with a history of alcohol use disorder in sustained remission for five years, no other psychiatric history, who was admitted to neurology for encephalopathy developed after a hernia repair surgery. His neurological work up including MRI brain, CSF analysis, Vit B12, TSH, video EEG, all of which were normal. The neurology team considered treating the patient with steroids for possible autoimmune encephalitis. They consulted psychiatry as he demonstrated posturing and echolalia. Upon psychiatric evaluation, his presentation was notable for stupor, mutism and negativism. He showed modest response to an initial lorazepam challenge with improved speech. Upon receiving a second dose of lorazepam, the response was significant, marked by improvement in his speech, thought process, and the ability to verbalize his subjective experience . As his catatonia improved, his depression was unmasked. He demonstrated depressed mood, feelings of guilt, helplessness, hopelessness, ruminations about past alcohol use, paranoia against the hospital staff, auditory hallucinations and referential thinking. His condition did not improve with aripiprazole or olanzapine, so team decided to administer electroconvulsive treatment in addition to escitalopram. Over the course of 7 index sessions, the patient showed minimal improvement. With a switch to bilateral ECT (index sessions #8-15), the patient ultimately showed significant improvement, including complete resolution of catatonia, and remission of depressive and psychotic symptoms. This was evidenced by improved mood, sleep, and consistent denial of AH and paranoia. He was discharged on maintenance ECT, escitalopram, and quetiapine. <h3>Methods</h3> Electronic searches of the standard bibliographic databases PubMed, MEDLINE, EMBASE, and PsycINFO will be performed for papers focusing on catatonia, first episode of depression and older adults. <h3>Results</h3> The literature on catatonia in older adults will be reviewed. The prevalence, complexities in diagnosis, and prognosis will be described, as available in the literature. <h3>Conclusions</h3> In the geriatric population, its crucial to identify and treat the catatonia in early stages to limit overall morbidity and preserve functioning. In some instances, the underlying etiology becomes evident after the treatment of catatonia. <h3>This research was funded by</h3> None