We present the case of a male patient with traumatic brain injury leading to gradual deterioration in functioning over several years, culminating in a state of prolonged treatment-resistant catatonia complicated by an inability to perform activities of daily living and necessitating total care by nursing staff. Extensive diagnostic evaluation did not reveal a convincing etiology of patient’s catatonia. Despite several empiric treatment modalities administered early in the course of catatonia, patient’s condition continued to decline. We did not observe sustained changes in response to high dose lorazepam, selegiline/minocycline coadministration, or ECT alone, but rather exponential improvement from the combination of medications and ECT.