Catatonia is a widespread problem in psychiatric hospitals as approximately 10% of patients present with catatonic symptoms upon admission.
Catatonia carries the risk of severe, even fatal complications. The first line treatment is usually electroconvulsive therapy (ECT) or
benzodiazepines, but ECT may not be readily available and
benzodiazepines may not always be effective. We describe the case of a patient presenting with severe symptoms of catatonic depression who completed a 3-day course of 25 mg
aripiprazole that rapidly resolved his catatonic symptoms. Several cases have already been reported where administration of
aripiprazole successfully resolved catatonic symptoms after other treatment options had failed.
Aripiprazole's efficacy and advantages may lie in its unique receptor profile. It acts as a
dopamine D2 receptor (D2 R) antagonist and partial D2 R agonist depending on the precise cellular milieu, which may explain its efficacy and favourable side effect profile compared to other
antipsychotics used to treat
catatonia.
Aripiprazole also partially agonises D3 receptors and
serotonin 2 C receptors (5-HT2 C), which may contribute to its
antidepressant properties.
Aripiprazole enhances
gamma-aminobutyric acid (
GABA) transmission in certain brain areas, and it is widely agreed that low
GABA activity may contribute to catatonic symptoms. Pharmacokinetics studies show that peak plasma levels are reached rapidly, within 2-3 hours of intramuscular administration and 4-6 hours of
oral administration. Administration of high-dose
aripiprazole (>25 mg/day) should be considered as a viable alternative to ECT and
benzodiazepines in patients presenting with catatonic symptoms.
Aripiprazole also carries a much lower risk of complications compared to other
antipsychotics.