Effective use of memantine for catatonia in major depressive disorder after failure of electroconvulsive therapy: A case report

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Effective use of memantine for catatonia in
major depressive disorder after failure of
electroconvulsive therapy: A case report

Tanifuji, Takaki ; Otsuka, Ikuo ; Atarashiya, Toshio ; Kimura, Atsushi
; Horai, Tadasu ; Okazaki, Satoshi ; Hishimoto, Akitoyo
(Citation)
Psychiatry and Clinical Neurosciences Reports,2(1):e84

(Issue Date)
2023-03

(Resource Type)
journal article

(Version)
Version of Record

(Rights)
© 2023 The Authors. Psychiatry and Clinical Neurosciences Reports published by John
Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.
This is an open access article under the terms of the Creative Commons AttributionNonCommercial-NoDerivs License, which permits use and distribution in any medium,…
provided
the original work is properly cited, the use is non-commercial and no
(URL)
modifications or adaptations are made.
https://hdl.handle.net/20.500.14094/0100485164

DOI: 10.1002/pcn5.84

LETTER TO THE EDITOR

Effective use of memantine for catatonia in major depressive
disorder after failure of electroconvulsive therapy:
A case report
Catatonia is a neuropsychiatric disease characterized by abnormal

function and failure to achieve remission. The patient was

psychomotor signs, such as immobility or excessive motor activity.

transferred to our hospital.

The diagnosis is confirmed when at least three of the following

As the patient had been in a stupor and could not take oral

symptoms are observed: stupor, catalepsy, waxy flexibility,

intake, a nasogastric tube was inserted. In addition to quetiapine

mutism, negativism, posturing, mannerisms, stereotypy, agitation,

at 200 mg/day that had been previously prescribed, we started

1

grimacing, echolalia, or echopraxia. According to a meta‐analysis

lorazepam at 3 mg/day and increased that to 27 mg/day (by

of 74 studies, the prevalence of catatonia was approximately 9%

1–2 mg/day, while assessing the patient's response to the

and it is often comorbid with psychiatric disorders and medical

treatment at intervals of 2–3 days). We ruled out other medical

illness.2 While benzodiazepine and electroconvulsive therapy

problems with the help of a neurologist's consultation as well as

(ECT) are standard treatments for catatonia,3–5 approximately

blood tests, cerebrospinal fluid tests, electroencephalogram, CT,

5

A recent

and magnetic resonance imaging (MRI), beginning the administra-

systematic review has referred to glutamate receptor antagonist

tion of memantine because of the poor efficacy of lorazepam in

medications as the option following benzodiazepine medication

catatonia. After increasing the memantine dose to 20 mg, the

and ECT.3 In this case report, we describe a major depressive

agitation improved, and the patient could speak with us. However,

30% of patients with catatonia fail to improve.

disorder (MDD) patient with treatment‐resistant catatonia who

the eosinophil levels elevated, and the patient complained of

did not respond to ECT and benzodiazepine medication; the

depressive symptoms; amitriptyline at 30 mg/day was initiated.

symptoms were improved on the administration of memantine, a

Memantine was discontinued due to elevated eosinophils as a

glutamate receptor antagonist.

suspected side‐effect, which in turn led to the exacerbation of

A 54‐year‐old male patient presented with a medical history

agitation. We decreased the dosages of amitriptyline and

of Guillain–Barre syndrome and myocardial infarction. At age 50,

quetiapine, and increased the olanzapine dosage to manage the

he had had insomnia due to stress from work and family problems

increase in agitation. Lorazepam dosages were reduced because

and was prescribed a hypnotic at a nearby clinic. At age 52, his

high doses of it did not achieve remission, and we found that

depressive symptoms had gradually worsened. He was diagnosed

memantine did not increase eosinophil and decided to re‐

with MDD and prescribed mirtazapine 15 mg/day, which im-

administer it because increased eosinophil had been lasting after

proved his symptoms. At age 53, his depressive symptoms had

discontinuation of administration. Consequently, the agitation and

relapsed, which retarded his thinking and interfered with his daily

stupor gradually improved, and the patient was able to eat, walk

life; he was admitted to a psychiatric hospital. After that, he

by himself, and speak. Finally, he was discharged on the 186th day

additionally presented with stupor, catalepsy, mutism, negativ-

from admission (the course of catatonia symptoms and treatment

ism, and agitation. The blood samples and head computed

is shown in Figure 1).

tomography (CT) scans showed no abnormal findings. Following

To our best knowledge, this is the first case report of memantine

an intravenous injection of 10 mg diazepam, his symptoms

improving the symptoms of an MDD patient with treatment‐resistant

partially improved, and he was diagnosed with catatonia.

catatonia who did not respond to ECT and high doses of

Lorazepam was administered at a dose of 8 mg/day; however, it

benzodiazepine medication without any sequelae. A previous case

did not lead to remission. Additionally, the creatinine kinase (CK)

report revealed that ECT could not improve the symptoms of an

levels elevated to 1100 U/L, and the body temperature rose to

MDD patient with catatonia, and was effectively improved by

37.5°C; the medical team decided to perform ECT. After the

amantadine, which is a glutamate receptor antagonist medication,

eighth ECT session, the patient presented with impaired cognitive

like memantine.6 We suggest that glutamate receptor antagonists

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any
medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
© 2023 The Authors. Psychiatry and Clinical Neurosciences Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and
Neurology.
Psychiatry Clin. Neurosci. Rep. 2023;2:e84.
https://doi.org/10.1002/pcn5.84

wileyonlinelibrary.com/journal/pcn5

|

1 of 3

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FIGURE 1

LETTER TO THE EDITOR

The courses of catatonia symptoms and treatment. ECT, electroconvulsive therapy.

may be an effective medication for MDD patients with ECT and

C L I N I C A L T RI A L RE G I S T RA T I O N

benzodiazepine‐resistant catatonia.

N/A

A U T H O R C O N TR I B U T I O N S

FU N D I NG I NF O RM AT I ON

Akitoyo Hishimoto designed the research procedure. Takaki Tanifuji

None

was responsible for drafting of the manuscript. Takaki Tanifuji, Ikuo
Otsuka, Toshio Atarashiya, Atsushi Kimura, Tadasu Horai, and Satoshi

Takaki Tanifuji MD1

Okazaki collected the data. Ikuo Otsuka mainly revised the manu-

Ikuo Otsuka MD, PhD1

script. All authors read and approved the final submission.

Toshio Atarashiya MD2
Atsushi Kimura MD, PhD1
Tadasu Horai MD, PhD1

CO NFL I CT OF INTERES T S T ATEME NT
N/A

Satoshi Okazaki MD, PhD1
Akitoyo Hishimoto MD, PhD1,3

D A TA A V A I L A B I L I T Y S T A T E M E N T
Requests to access these datasets should be directed to the
corresponding author.

1

Department of Psychiatry,

Kobe University Graduate School of Medicine, Kobe, Japan
2

Department of Psychiatry,

E T H IC S APP ROV AL S T A T E ME N T
We implemented this study design and all related procedures in

Momonosato Hospital, Kasaoka, Okayama, Japan
3

Department of Psychiatry,

accordance with the Declaration of Helsinki. This study was not

Yokohama City University Graduate School of Medicine, Yokohama,

approved by the Ethical Committee because it is a case report. We

Japan

explained the off‐label use of memantine to the patient and family
and obtained their consent.

Correspondence
Akitoyo Hishimoto, MD, PhD, Department

PA TI E NT CO N S EN T S T A T EME NT
The patient provided informed consent to receive treatment and for
the publication of this case report. We gave consideration to
preserve the anonymity of the patient.

of Psychiatry, Yokohama City University Graduate
School of Medicine, 3‐9 Fukuura, Kanazawa,
Yokohama 236‐0004, Japan.
Email: hishipon@yokohama-cu.ac.jp

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2 of 3

ORCID
Takaki Tanifuji

3.

http://orcid.org/0000-0002-6308-9255
4.

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