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Catatonia Medication

  • Author: James Robert Brasic, MD, MPH; Chief Editor: Selim R Benbadis, MD  more...
Updated: Jul 09, 2015

Medication Summary

Medications that may be used in the treatment of patients suffering from catatonia include benzodiazepines, carbamazepine, zolpidem, tricyclic antidepressants (TCAs), muscle relaxants, amobarbital, reserpine, thyroid hormone, lithium carbonate, bromocriptine, and neuroleptics.

Because neuroleptic malignant syndrome (NMS) may occur in patients with symptoms and signs of catatonia, prudent clinicians use neuroleptics, including atypical neuroleptics, with caution. 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 this combination is given, even if an atypical neuroleptic is used.


Anxiolytics, Benzodiazepines

Class Summary

By binding to specific receptor sites, benzodiazepines appear to potentiate the effects of gamma-aminobutyric acid (GABA) and facilitate inhibitory GABA neurotransmission and the action of other inhibitory transmitters.

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 central nervous system (CNS), including the limbic and reticular formations. After a lorazepam dose is administered, the patient's blood pressure should be monitored. The dose is adjusted as necessary.

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 is an alternative for the termination of refractory status epilepticus. Because it is water-soluble, it takes approximately 3 times longer than diazepam to reach peak electroencephalographic (EEG) effects. Therefore, the clinician must wait 2-3 minutes to evaluate midazolam's sedative effects fully. Midazolam has twice the affinity for benzodiazepine receptors that diazepam does. It may be administered intramuscularly (IM) if intravenous (IV) 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.

Valproic acid (Depakote, Depakote ER)


Valproic acid may be helpful by increasing activity at GABA or modest antiglutaminergic effects.


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 interfere 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 depletes norepinephrine and dopamine, and this depletion 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 Throid, 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 this combination is given, even if the neuroleptic is an atypical one.


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.

Olanzapine (Zyprexa)


The effects of olanzapine are mediated through combined antagonism of dopamine and serotonin type 2 receptor sites.

Clozapine (Clozaril, FazaClo)


Clozapine has been reported to improve catatonia in psychosis, perhaps via a greater pass-though of dopamine to the D2 receptor.


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 TCAs has been shown in case reports to be helpful in some cases of catatonia.

Amitriptyline hydrochloride


Amitriptyline is an analgesic indicated for certain chronic and neuropathic pain.

Clomipramine (Anafranil)


Clomipramine is a dibenzazepine compound belonging to the TCA family. It inhibits the membrane pump mechanism responsible for the uptake of norepinephrine and serotonin in adrenergic and serotonergic neurons. Clomipramine affects serotonin uptake and affects norepinephrine uptake when converted into its metabolite, desmethylclomipramine. These actions are believed to be responsible for clomipramine's antidepressant activity.



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 proved 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)


Desipramine is the original TCA used for depression. It and similar agents appear to act by inhibiting reuptake of noradrenaline at synapses in central descending pain-modulating pathways located in the brainstem and spinal cord.

Contributor Information and Disclosures

James Robert Brasic, MD, MPH Assistant Professor, Russell H Morgan Department of Radiology and Radiological Science, Division of Nuclear Medicine, Johns Hopkins University School of Medicine; Active Staff, Department of Radiology and Radiological Science, Division of Nuclear Medicine, Johns Hopkins Hospital; Courtesy Staff, Department of Radiology, Johns Hopkins Bayview Medical Center

James Robert Brasic, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Neurology, International Parkinson and Movement Disorder Society

Disclosure: Received royalty from Medscape for other; Received royalty from Neuroscience-Net, LLC for other; Received grant/research funds from National Institutes of Health for other.

Chief Editor

Selim R Benbadis, MD Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cyberonics; Eisai; Lundbeck; Sunovion; UCB; Upsher-Smith<br/>Serve(d) as a speaker or a member of a speakers bureau for: Cyberonics; Eisai; Glaxo Smith Kline; Lundbeck; Sunovion; UCB<br/>Received research grant from: Cyberonics; Lundbeck; Sepracor; Sunovion; UCB; Upsher-Smith.


Nestor Galvez-Jimenez, MD, MSc, MHA Chairman, Department of Neurology, Program Director, Movement Disorders, Department of Neurology, Division of Medicine, Cleveland Clinic Florida

Nestor Galvez-Jimenez, MD, MSc, MHA is a member of the following medical societies: American Academy of Neurology, American College of Physicians, and Movement Disorders Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment


The research for this article was supported by the Essel Foundation; the National Alliance for Research on Schizophrenia and Depression (NARSAD); the Tourette Syndrome Association, Inc; the National Institutes of Health; and the Department of Psychiatry of Bellevue Hospital Center and the New York University School of Medicine, New York, New York. The cooperation of the Health and Hospitals Corporation of the City of New York is gratefully acknowledged.

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Table. Causes of Catatonia by Category
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


Atrophy of left amygdala[17]

Autistic disorder[6, 7, 8, 18, 19, 20, 21, 22, 23]

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


Encephalitis (herpesvirus, Trypanosoma cruzi)

Encephalopathy (Borrelia burgdorferi, HIV infection, Wernicke encephalopathy)

Familial fatal insomnia[24]

Fibromuscular dysplasia with dissection of basilar artery

Frontal lobotomy

Head injury

Huntington disease


Hypopituitarism secondary to postpartum hemorrhage

Idiopathic recurring stupor

Inherited neurometabolic disorders

Locked-in syndrome

Meningitis, tuberculous


Multiple sclerosis[25, 26]


Nonconvulsive status epilepticus

Pervasive developmental disorders[7, 8, 22]

Pallidoluysian atrophy

Paraneoplastic encephalitis[27]


Postencephalitic parkinsonism

Progressive multifocal leukoencephalopathy

Progressive supranuclear palsy


Seizures (complex with partial symptomatology)

Stiff-man syndrome



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 (lethargic) encephalitis

Wilson disease

Psychiatric conditions Acute stress disorder

Anorexia nervosa

Autistic disorder[6]

Brief reactive psychosis with catatonia

Conversion disorder


Major depression, single episode with catatonic features

Mood disorders

Neuroleptic malignant syndrome[15]

Posttraumatic stress disorder


Substance intoxication (3,4-methylenedioxymethamphetamine [“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 AIDS

Acute intermittent porphyria

Addison disease

Bacterial septicemia


Carcinoid tumors

Diabetic ketoacidosis

Encephalopathy (hepatic, HIV infection, Wernicke encephalopathy)

Fever of unknown cause

Heat stroke

Hepatic failure

Hereditary coproporphyria







Intestinal atony


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)


Systemic lupus erythematosus

Thermal injury

Thrombotic thrombocytopenic purpura


Typhoid fever


Von Economo (lethargic) encephalitis

Obstetric conditions Hypopituitarism secondary to postpartum hemorrhage
*Administration of agents that block postsynaptic dopamine receptors is associated with the onset of catatonia in some individuals.
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