“Mr. A” was 46-year-old man with schizoaffective disorder with catatonic features. He was admitted for disorganized behavior and mutism. His medications were continued, including bupropion, risperidone, and lithium, and low-dose aripiprazole was added. Ten days of treatment led to increasing depression. ECT was initiated for treatment-resistant depressive symptoms and catatonic features. Six treatments with unilateral, nondominant electrodes were administered without any notable effect. Two days later, rigidity and increased creatine phosphokinase, without fever or autonomic instability, led to diagnosis of atypical neuroleptic malignant syndrome (NMS). He was treated with dantrolene, amantadine, and bromocriptine for 1 week. Despite resolution of signs of NMS, his catatonia persisted. Lorazepam trials improved his rigidity, but made him very agitated, requiring restraints. A zolpidem-challenge test was administered, showing partial resolution of rigidity and mutism. He was started on zolpidem 10 mg tid. On the 5th day, zolpidem was increased to 10 mg q 6 hrs., and divalproex 500 mg q 8 hrs. was added to treat the mood disturbance underlying his catatonia. Four weeks later, with complete resolution of his catatonia, he was discharged on zolpidem 10 mg tid for 3 months and divalproex 1,500 mg daily.