Catatonia Medication
- Author: James Robert Brasic, MD, MPH; Chief Editor: Selim R Benbadis, MD more...
Medication Summary
The following medications may be used in the treatment of patients suffering from catatonia[71] :
- Benzodiazepines (eg, clonazepam, lorazepam, midazolam)
- Carbamazepine
- Zolpidem
- Tricyclic antidepressants
- Muscle relaxants
- Amobarbital
- Reserpine
- Thyroid hormone
- Lithium carbonate
- Bromocriptine
- Neuroleptics[80, 81]
Because neuroleptic malignant syndrome may occur in patients with symptoms and signs of catatonia, prudent clinicians cautiously use of neuroleptics, including atypical neuroleptics.[81] Although success has been reported in cases of catatonia treated with a combination of lithium and a neuroleptic, the risk of adverse effects must be considered when combining lithium and a neuroleptic, including an atypical neuroleptic.
Anxiolytics, Benzodiazepines
Class Summary
By binding to specific receptor sites, these agents appear to potentiate the effects of GABA and facilitate inhibitory GABA neurotransmission and the action of other inhibitory transmitters. Krivoy and colleagues recommended the addition of benzodiazepines to antipsychotics in the treatment of catatonia.[82]
Lorazepam (Ativan)
Lorazepam is a sedative hypnotic with a short onset of effects and a relatively long half-life. By increasing the action of GABA, which is a major inhibitory neurotransmitter in the brain, it may depress all levels of the CNS, including the limbic and reticular formation. Monitor the patient's blood pressure after administering a dose of lorazepam. Adjust the dose as necessary.
Lorazepam has been reported to reduce the serum levels of brain-derived neurotrophic factor and to ameliorate the symptoms and signs of catatonia in patients with schizophrenia.[83]
A 38-year-old woman with idiopathic catatonia required maintenance treatment with 6 mg lorazepam orally daily.[84]
Clonazepam (Klonopin)
Clonazepam is a long-acting benzodiazepine that increases presynaptic GABA inhibition and reduces the monosynaptic and polysynaptic reflexes. It suppresses muscle contractions by facilitating inhibitory GABA neurotransmission and the action of other inhibitory transmitters.
Midazolam
Midazolam is used as an alternative drug for the termination of refractory status epilepticus. Because it is water soluble, this agent takes approximately 3 times longer than diazepam to reach peak electroencephalogram (EEG) effects. Therefore, the clinician must wait 2-3 minutes to fully evaluate midazolam's sedative effects. Midazolam has twice the affinity for benzodiazepine receptors as diazepam. It may be administered intramuscularly if intravenous access cannot be obtained.
Anticonvulsants, Other
Class Summary
The use of certain anticonvulsants has proven helpful in some cases of catatonia.
Carbamazepine (Tegretol, Carbatrol, Epitol, Equetro)
Carbamazepine's mechanism of action may include modulation of voltage-dependent sodium channels.
Anticonvulsants, Barbiturates
Class Summary
The use of certain anticonvulsants has proven helpful in some cases of catatonia.
Amobarbital (Amytal)
Amobarbital is a sedative hypnotic with anticonvulsant properties that interferes with the transmission of impulses from the thalamus to the cortex.
Anxiolytics, Nonbenzodiazepine
Class Summary
The use of certain nonbenzodiazepine anxiolytics has been shown to be helpful in some cases of catatonia.
Zolpidem (Ambien, Edluar, ZolpiMist)
Zolpidem increases neural hyperpolarization by enhancing the activity of the inhibitory neurotransmitter GABA through selective agonist activity at the benzodiazepine-1 receptor.
Skeletal Muscle Relaxants
Class Summary
The use of certain skeletal muscle relaxants has been shown to be helpful in some cases of catatonia.
Dantrolene (Dantrium, Revonto)
Dantrolene acts directly on skeletal muscle by interfering with the release of calcium ions from the sarcoplasmic reticulum.
Central Monoamine-Depleting Agents
Class Summary
The use of central monoamine-depleting agents has been shown in case reports to be helpful in some cases of catatonia.
Reserpine
Reserpine depletes norepinephrine and dopamine, which may result in reduced blood pressure and sedative effects.
Thyroid Products
Class Summary
The use of thyroid products has been shown in case reports to be helpful in some cases of catatonia.
Thyroid, Desiccated (Armour Thyroid, Nature Thyroid, Westhroid)
Thyroid hormone is involved in normal metabolism, gluconeogenesis, utilization and mobilization of glycogen, and stimulation of protein synthesis.
Antipsychotics, Other
Class Summary
The use of antipsychotic products has been shown in case reports to be helpful in some cases of catatonia.
Lithium carbonate (Lithobid)
A case report has described successful lithium treatment in a patient with long-standing periodic catatonia. Although success has been reported in cases of catatonia treated with a combination of lithium and a neuroleptic, the risk of adverse effects must be considered when combining lithium with a neuroleptic, including an atypical neuroleptic.
Antipsychotics, 2nd Generation
Class Summary
The use of second-generation antipsychotic products has been shown in case reports to be helpful in some cases of catatonia.[80, 81]
Olanzapine (Zyprexa)
The effects of olanzapine are mediated through combined antagonism of dopamine and serotonin type 2 receptor sites.[80]
Ergot Derivatives
Class Summary
The use of ergot derivatives has been shown in case reports to be helpful in some cases of catatonia.
Bromocriptine (Parlodel, Cycloset)
Bromocriptine activates postsynaptic dopamine receptors in the tuberoinfundibular and nigrostriatal pathways. A case report on a patient with catatonia described successful treatment with bromocriptine.
Antidepressants, TCAs
Class Summary
The use of tricyclic antidepressants has been shown in case reports to be helpful in some cases of catatonia.
Amitriptyline hydrochloride
This agent is an analgesic indicated for certain chronic and neuropathic pain.
Clomipramine (Anafranil)
Clomipramine is a dibenzazepine compound belonging to the family of tricyclic antidepressants. The drug inhibits the membrane pump mechanism responsible for the uptake of norepinephrine and serotonin in adrenergic and serotonergic neurons.
Clomipramine affects serotonin uptake, while it affects norepinephrine uptake when converted into its metabolite desmethylclomipramine. It is believed that these actions are responsible for its antidepressant activity.
Doxepin (Silenor)
Doxepin increases the concentration of serotonin and norepinephrine in the CNS by inhibiting their reuptake by the presynaptic neuronal membrane. It inhibits histamine and acetylcholine activity and has proven useful in treatment of various forms of depression associated with chronic pain.
Nortriptyline (Pamelor)
Nortriptyline has demonstrated effectiveness in the treatment of chronic pain.
Desipramine (Norpramin)
This is the original TCA used for depression. These agents have been suggested to act by inhibiting reuptake of noradrenaline at synapses in central descending pain modulating pathways located in the brainstem and spinal cord.
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| Category | Causes |
| Neurologic conditions | Neuroleptic malignant syndrome[15] Administration of agents that block postsynaptic dopamine receptors* Administration of sibutramine,[16] withdrawn from US market October 8, 2010 Withdrawal of lorazepam and other sedatives Akinetic-rigid syndrome Arachnoid cyst in right parietal region Astrocytoma Atrophy of left amygdala[17] Autistic disorder[6, 7, 8, 18, 19, 20, 21, 22, 23] {{197} Basilar artery thrombosis Bilateral hemorrhagic lesions of temporal lobes Cerebellar catalepsy Cerebral hemorrhage Cerebral infarct Cerebrovascular disease Cortical venous thrombosis Central pontine myelinolysis Cortical basal ganglionic degeneration Dystonia Encephalitis (herpes, Trypanosoma cruzi) Encephalopathy (Borrelia burgdorferi, human immunodeficiency virus [HIV] infection, Wernicke encephalopathy) Familial fatal insomnia[24] Fibromuscular dysplasia with dissection of basilar artery Frontal lobotomy Head injury Huntington disease Hydrocephalus Hypopituitarism secondary to postpartum hemorrhage Idiopathic recurring stupor Inherited neurometabolic disorders Locked-in syndrome Meningitis, tuberculous Meningoencephalitis Multiple sclerosis[25, 26] Neurosyphilis Nonconvulsive status epilepticus Pervasive developmental disorders[7, 8, 22] Pallidoluysian atrophy Paraneoplastic encephalitis[27] Parkinsonism Postencephalitic parkinsonism Progressive multifocal leukoencephalopathy Progressive supranuclear palsy Schizencephaly Seizures (complex with partial symptomatology) Stiff-man syndrome Stroke Stupor Subarachnoid hemorrhage Subdural hematoma Substance intoxication (alcohol, disulfiram, organic fluorides, phencyclidine) Subthalamic mesencephalic tumor Surgical removal of cerebellar tumor Tay-Sachs disease Temporal lobe epilepsy Tuberous sclerosis Tumors (corpus callosum, glioma of third ventricle, supraventricular diffuse pinealoma) Vegetative state Von Economo encephalitis Wilson disease |
| Psychiatric conditions | Acute stress disorder Anorexia nervosa Autistic disorder[6] Brief reactive psychosis with catatonia Conversion disorder Hysteria Major depression, single episode with catatonic features Mood disorders Neuroleptic malignant syndrome[15] Posttraumatic stress disorder Schizophrenia Substance intoxication (3,4-methylenedioxymethamphetamine [ie, "ecstasy"], alcohol, amphetamine, phencyclidine, substance withdrawal, hypnotic-sedative, lorazepam) |
| Psychological factors | Immigration Experiencing rejection of an expression of love Feelings of alienation in an unfamiliar country |
| Medical conditions | Acquired immunodeficiency syndrome (AIDS) Acute intermittent porphyria Addison disease Bacterial septicemia Bronchorrhea Carcinoid tumors Diabetic ketoacidosis Encephalopathy (hepatic, HIV infection ? related, Wernicke) Fever of unknown cause Heat stroke Hepatic failure Hereditary coproporphyria Homocystinuria Hypercalcemia Hyperparathyroidism Hyperthyroidism Hyponatremia Hypothermia Intestinal atony Malaria Neuroleptic malignant syndrome[15] Poisoning (carbon monoxide, tetraethyl lead) Renal failure Substance intoxication (alcohol, cyclosporine, disulfiram, organic fluorides, phencyclidine) Syndrome of inappropriate antidiuretic hormone (SIADH) Syphilis Systemic lupus erythematosus Thermal injury Thrombotic thrombocytopenic purpura Tuberculosis Typhoid fever Uremia Von Economo encephalitis |
| Obstetric conditions | Hypopituitarism secondary to postpartum hemorrhage |
| *The administration of agents that block postsynaptic dopamine receptors is associated with the onset of catatonia in some individuals. | |
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