Ketamine for catatonia: A novel treatment for an old clinical challenge? A systematic review of the evidence.
Ana Teresa Caliman-Fontes, Flávia Vieira, Gustavo C. Leal, Beatriz A Carneiro, Yana Quarantini-Alvim, Taiane V Andrade, Rodrigo P Mello, Ary Gadelha, Acioly L T Lacerda, Lucas C Quarantini
Schizophrenia Research September 1, 2024 DOI: 10.1016/j.schres.2024.07.055 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Peer reviewed |
|---|---|
| Sample size | 25 |
| Population | Catatonic patients receiving ketamine or esketamine |
| Interventions | Ketamine Esketamine |
| Topics | Esketamine Ketamine |
| Keywords | Mental-health Psychiatric-treatment Ketamine-therapy Catatonia-research Breakthrough-medicine |
| Citations | 7 |
| Key findings | Ketamine treatment for catatonia yielded 80% response and 44% remission rates with no worsening of psychotic symptoms, challenging its traditional contraindication in psychotic disorders. |
Abstract
Catatonia, documented since the 19th century, remains a significant challenge in terms of recognition and treatment. Over the last two decades, ketamine has brought new perspectives to psychiatry, sparking widespread interest. Concurrently, catatonia has attracted heightened scientific attention. Preliminary evidence suggests the therapeutic potential of ketamine for catatonia. We systematically searched Medline/PubMed, Embase, PsycINFO, Lilacs, and Cochrane Library databases, as well as Google Scholar, for studies with ketamine or its enantiomers as intervention for catatonia, with no restrictions to underlying diagnosis, date, language, or study design. Twenty articles were included, encompassing a total of 25 catatonic patients receiving ketamine or esketamine. Predominantly female (61.9 %), with a mean age of 44.4 years, patients mostly exhibited manifestations compatible with the retarded subtype of catatonia. Mood disorders were the most prevalent underlying diagnoses. Ketamine was primarily administered intravenously over a 40-minute period and in multiple-dosing schemes. Mean response and remission rates of catatonic manifestations for the whole sample were 80 % and 44 %, respectively, with no reports of worsening catatonic features or psychotic symptoms. Only one patient discontinued treatment due to intolerable dissociative effects. Challenging the conventional contraindication of ketamine in psychotic disorders, current evidence highlights its potential efficacy, particularly in treating catatonia. Pending further research, we advocate reevaluating this contraindication, as it may offer a promising therapeutic option, especially for challenging cases. Preliminary evidence suggests potentially greater benefits for catatonic patients with underlying mood disorders compared to primary psychotic disorders.
Comparable studies
Other systematic reviews and meta-analyses on ketamine, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta-analysis Depressed patients with suicidal ideation at baseline | 2017 | Systematic review and individual participant data meta-analysis | n = 167 |
| Ketamine use: a review Ketamine users | 2011 | Systematic review | |
| Ketamine and Other NMDA Antagonists: Early Clinical Trials and Possible Mechanisms in Depression Participants with major depression in placebo-controlled, double-blind, randomized... | 2015 | Systematic review and meta-analysis | |
| Ketamine and postoperative pain – a quantitative systematic review of randomised trials Surgical patients from 25 countries | 2004 | Systematic review | n = 2,839 |
| Side-effects associated with ketamine use in depression: a systematic review. Patients with depression | 2018 | Systematic review |
Citations in the library
Cited by 5
- Intravenous ketamine successfully treats treatment-resistant catatonia in schizophrenia: A case report. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy October 1, 2024
- Ketamine for negative and depressive symptoms in schizophrenia: the evidence so far. Frontiers in Psychiatry 2026
- The Lysing of Catatonia With Intravenous Ketamine Prior to Definitive Treatment With Electroconvulsive Therapy. The Journal of ECT April 15, 2025
- Low-dose intravenous esketamine on a depressive catatonia patient with venous thromboembolism: a case report. Frontiers in Psychiatry 2025
- Implementation and Preliminary Evaluation of an Intravenous Ketamine Protocol for Psychiatric Conditions in Medical and Surgical Units: A One-Year Pilot Study. Journal of the Academy of Consultation-Liaison Psychiatry September 21, 2026
Cites 10
- Comparative efficacy of racemic ketamine and esketamine for depression: a systematic review and meta-analysis Journal of Affective Disorders September 23, 2020
- Ketamine: 50 Years of Modulating the Mind Frontiers in Human Neuroscience November 29, 2016
- Ketamine as an alternative to ECT in catatonia in elderly women with bipolar disorder: A case report. Frontiers in Psychiatry 2023
- Oral and Intranasal Ketamine Use in Treatment-Resistant Catatonia: A Clinical Case Report. The American journal of case reports April 25, 2023
- Catatonia-Like Syndrome Treated With Low-Dose Ketamine. Journal of Emergency Medicine January 27, 2020
and 5 more in the library