The Lysing of Catatonia with Intravenous Ketamine Prior to Definitive Treatment with Electroconvulsive Therapy
Location
Center for Advanced Learning and Simulation (CALS)
Publication Date
April 2025
Start Date
17-4-2025 8:00 AM
Description
Catatonia refractory to routine pharmacologic management is often managed by electroconvulsive therapy (ECT). However, legal obstacles may delay ECT initiation, potentially leading to risks associated with prolonged immobility and resulting in additional medical procedures. We present a case of successful catatonia lysis with intravenous (IV) ketamine that allowed a patient to avoid potential complications and other procedures prior to definitive treatment with ECT. A 21-year-old female with an unknown psychiatric history presented after becoming decreasingly interactive and not eating over several weeks. The patient had become depressed and paranoid, and she stopped taking care of herself or interacting with others. She was admitted to inpatient psychiatry and started on escitalopram, risperidone, and lorazepam 1 mg by mouth or 0.5 mg intramuscularly three times daily (TID). Increases in lorazepam were not possible due to hypotension. The patient did not show any signs of improvement and continued not to eat or drink. While waiting for judicial approval of ECT, it was decided to attempt to lyse the catatonia with ketamine infusions. The patient received an IV infusion of 32.2 mg ketamine over one hour. After the infusion, the patient followed simple commands and gave short verbal responses. Infusions were continued three times weekly with 65 mg ketamine per treatment. Following two infusions, she was able to minimally participate during interview, and she began eating and ambulating without assistance. The patient continued to display improvement in catatonic symptoms with subsequent infusions. Following nine infusions, she continued to report suicidal ideation and auditory hallucinations. Ketamine treatments were discontinued following the tenth infusion, and ECT was initiated to treat residual symptoms. A small number of case studies have reported success using ketamine for catatonia treatment. This case adds to the existing literature supporting therapeutic potential. More research is needed regarding this potential option for treatment.
Recommended Citation
Stielper, Zachary MD, PhD; Mermilliod, Isabelle; Eng, Matthew; and Conrad, Erich, "The Lysing of Catatonia with Intravenous Ketamine Prior to Definitive Treatment with Electroconvulsive Therapy" (2025). Dept. of Psychiatry Research Symposium. 1.
https://digitalscholar.lsuhsc.edu/psych_rd/2025/presentations/1
The Lysing of Catatonia with Intravenous Ketamine Prior to Definitive Treatment with Electroconvulsive Therapy
Center for Advanced Learning and Simulation (CALS)
Catatonia refractory to routine pharmacologic management is often managed by electroconvulsive therapy (ECT). However, legal obstacles may delay ECT initiation, potentially leading to risks associated with prolonged immobility and resulting in additional medical procedures. We present a case of successful catatonia lysis with intravenous (IV) ketamine that allowed a patient to avoid potential complications and other procedures prior to definitive treatment with ECT. A 21-year-old female with an unknown psychiatric history presented after becoming decreasingly interactive and not eating over several weeks. The patient had become depressed and paranoid, and she stopped taking care of herself or interacting with others. She was admitted to inpatient psychiatry and started on escitalopram, risperidone, and lorazepam 1 mg by mouth or 0.5 mg intramuscularly three times daily (TID). Increases in lorazepam were not possible due to hypotension. The patient did not show any signs of improvement and continued not to eat or drink. While waiting for judicial approval of ECT, it was decided to attempt to lyse the catatonia with ketamine infusions. The patient received an IV infusion of 32.2 mg ketamine over one hour. After the infusion, the patient followed simple commands and gave short verbal responses. Infusions were continued three times weekly with 65 mg ketamine per treatment. Following two infusions, she was able to minimally participate during interview, and she began eating and ambulating without assistance. The patient continued to display improvement in catatonic symptoms with subsequent infusions. Following nine infusions, she continued to report suicidal ideation and auditory hallucinations. Ketamine treatments were discontinued following the tenth infusion, and ECT was initiated to treat residual symptoms. A small number of case studies have reported success using ketamine for catatonia treatment. This case adds to the existing literature supporting therapeutic potential. More research is needed regarding this potential option for treatment.
Comments
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