Because of its N-methyl-d-aspartic acid antagonist properties, amantadine (100–500 mg three times a day), and its derivative memantine (5–20 mg/day), have been tried in catatonia.
Carroll and coworkers identified 25 cases of amantadine and memantine use in the treatment of catatonia. All cases improved, mostly after 1–7 days.
- It should be noted, however, that six were unpublished, and that seven other were cases experiencing a “catatonia-parkinsonian syndrome” while under treatment with the high-potency neuroleptic drugs haloperidol or fluphenazine.
- The symptoms diminished when neuroleptics were tapered, and they added amantadine. Since then, they have published eleven additional cases describing the successful use of amantadine or memantine in catatonia.
- In one case, in an adolescent girl, catatonia that was resistant to ECT improved after the addition of amantadine.
- Only in a review of Hawkins and coworkers, they report a case in which the use of amantadine remained without effect. Should acknowledge, however, that negative cases are less likely to be published.
- Given these positive signals in the published literature, and evidence of its efficacy in treating the negative and cognitive symptoms of schizophrenia, amantadine should be further studied as a feasible treatment option for catatonia. There is anecdotal evidence from case reports on the use of various other pharmacological agents, such as bromocriptine and biperiden.
- Based on the GABA-hypothesis of catatonia, and the GABA-related working mechanism of several anti-convulsive mood stabilizers, these drugs have been proposed as a viable treatment option to treat catatonia in bipolar patients.
- Only a few cases have published reports.
- They used valproate in several case reports and found not only to have prophylactic effects but also “an improving effect on the catatonic symptoms”.
- In a solitary case report, they advocated levetiracetam as a treatment for catatonia in bipolar disorder, given its mood-stabilizing efficacy.
- It is of note, however, that levetiracetam has also been described to provoke catatonia.
- Using topiramate and carbamazepine have also been reported.
- Although lithium has been anecdotally reported to have a beneficial effect on acute catatonic symptoms, they mostly describe it to be of use in the prevention of recurrent catatonia, albeit with sometimes limited results.
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- Babington PW, Spiegel DR. Treatment of catatonia with olanzapine and amantadine. Psychosomatics (2007) 48(6):534–6.10.1176/appi.psy.48.6.534
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