Treatment of Catatonia with Benzodiazepine, Electroconvulsive Therapy and Memantine in an Adolescent: a Case Report

Catatonia is a severe psychomotor syndrome that can be life-threatening if not promptly diagnosed and treated. While benzodiazepines and electroconvulsive therapy (ECT) are established treatments for catatonia in adults, there is limited literature on their efficacy and safety in adolescents. Additionally, the use of N-methyl-D-aspartate (NMDA) antagonists, such as memantine, has been explored as a potential treatment option; however, there is a lack of extensive research in the pediatric population. We report the case of a 16-year-old boy who presented with refractory catatonia. The patient initially appeared to respond to lorazepam but experienced adverse effects, necessitating a switch to clonazepam. Despite some improvement, his condition deteriorated, leading to the initiation of ECT, which was associated with significant improvements. However, stagnation in clinical progress prompted the introduction of memantine, an NMDA antagonist. Memantine was well tolerated and appeared to contribute to further symptom resolution. The patient achieved full remission of catatonia in approximately 2 months and sustained well-being 19 weeks post-discharge with a treatment regimen of olanzapine, memantine and clonazepam. This case highlights the potential efficacy of combining benzodiazepines, ECT, and NMDA antagonists in treating refractory catatonia in adolescents. Our findings support considering NMDA antagonists in treatment protocols, particularly when conventional therapies are ineffective or inaccessible. Further research is needed to validate these results and establish comprehensive guidelines for managing pediatric catatonia.