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Review of Adjunctive Glutamate Antagonist Therapy in the Treatment of Catatonic Syndromes

Received August 30, 2006; revised December 17, 2006; accepted December 27, 2006. Dr. Carroll is affiliated with the University of Cincinnati, Ohio, and the Mental Health Care Line, Chillicothe, Ohio. Dr. Goforth is affiliated with Duke University Medical Center, and Durham Veterans Affairs, Durham, North Carolina. Dr. Thomas is affiliated with the University of Cincinnati, Ohio, and Chillicothe Veterans Affairs Medical Center, Chillicothe, Ohio. Dr. Ahuja if affiliated with Northumberland, Tyne and Wear NHS Trust and Newcastle University, Newcastle-on-Tyne, United Kingdom. Drs. McDaniel and Spiegel are affiliated with Eastern Virginia Medical School, Norfolk, Virginia. Dr. Kraus is affiliated with the University of Illinois, Chicago. Drs. Franco and Pozuelo are affiliated with the Cleveland Clinic Foundation, Cleveland, Ohio. Dr. Muñoz is affiliated with the Campo de Mayo Military Hospital, Buenos Aires, Argentina. Address correspondence to Dr. Carroll, Psychiatry Service, MHCL, VA Medical Center - 116A, 17273 State Route 104, Chillicothe, OH 45601; btcarroll1{at}cs.com (e-mail).

Catatonia is a common neuropsychiatric syndrome which may arise from GABA-A hypoactivity, dopamine (D2) hypoactivity,and possibly glutamate NMDA hyperactivity. Amantadine and memantine have been reported as effective treatments for catatonia in selected cases, and probably mediate the presence of catatonic signs and symptoms through complex pathways involving glutamate antagonism. The authors identified 25 cases of catatonia treated with either agent. This article provides indirect evidence that glutamate antagonists may improve catatonic signs in some patients who fail to respond to established treatment, including lorazepam or electroconvulsive therapy. Further study of glutamate antagonists in the treatment of catatonia is needed.

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