Successful treatment of intractable visual hallucinations with 5-HT 2A antagonist ketanserin.
Iris E C Sommer, Hidde Kleijer, Lucy Visser, Teus Van Laar
BMJ Case Reports June 27, 2018 DOI: 10.1136/bcr-2018-224340 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | One adult woman with schizophrenia and treatment-resistant hallucinations |
| Intervention | Ketanserin |
| Topics | Serotonin |
| Keywords | Humans Hallucinations Ketanserin Serotonin antagonists Treatment outcome Adult Female Schizophrenia Parkinson’s disease Therapeutic indications |
| Key findings | Ketanserin, a 5-HT2A receptor antagonist, significantly reduced visual but not auditory hallucinations in a patient with schizophrenia whose symptoms had persisted despite high-dose clozapine and transcranial magnetic stimulation. The authors suggest the 5-HT2A receptor may be involved specifically in visual hallucinations and describe this as the first report of ketanserin successfully reducing visual hallucinations in schizophrenia. |
Abstract
Hallucinations, visual, auditory or in another sensory modality, often respond well to treatment in patients with schizophrenia. Some, however, do not and can be very chronic and debilitating. We present a patient with schizophrenia with intractable hallucinations despite state of the art care, including high-dose clozapine and transcranial magnetic stimulation. Based on the possible role of the 5-HT2A receptor in hallucinations, we treated her with the antihypertensive drug ketanserin, a 5-HT2A receptor antagonist.This significantly reduced her visual but not her auditory hallucinations, suggesting a possible role of the 5HT2A receptor in the pathophysiology of specifically visual hallucinations. This is the first time ketanserin has been described to successfully reduce visual hallucinations in a patient with schizophrenia.
Comparable studies
Other case reports and case series on serotonin, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Lasting Neuropsychiatric Sequelae of (??)Methylenedioxymethamphetamine (???Ecstasy???) in Recreational Users Persons who ingested large doses of MDMA | 1991 | Case study | n = 2 |
| Striatal serotonin is depleted in brain of a human MDMA (Ecstasy) user Chronic MDMA user | 2000 | Case study | n = 1 |
| Death following ingestion of MDMA (ecstasy) and moclobemide People who died after ingesting moclobemide and MDMA | 2003 | Case series | n = 4 |
| Ecstasy Intoxication: An Overlap Between Serotonin Syndrome and Neuroleptic Malignant Syndrome A 19-year-old woman and 15 other cases reported in the literature | 1996 | Case report and literature review | n = 16 |
| Recurrent seizures and serotonin syndrome following "2C-I" ingestion. 19-year-old male who insufflated 2C-I | 2013 | Case report | n = 1 |
Citations in the library
Cited by 4
- A neurobiological perspective on social influence: Serotonin and social adaptation Journal of Neurochemistry March 11, 2022
- Cross-Species Evidence for Psilocin-Induced Visual Distortions: Apparent Motion Is Perceived by Both Humans and Rats. Biological Psychiatry Global Open Science September 1, 2025
- Cellular mechanisms of serotonergic psychedelics - apical hypercontextualisation. Neuroscience & Biobehavioral Reviews July 1, 2026
- From hallucinations to synaesthesia: A circular inference account of unimodal and multimodal erroneous percepts in clinical and drug-induced psychosis. Neuroscience and biobehavioral reviews April 2022
Cites 3
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- Activation of Serotonin 2A Receptors Underlies the Psilocybin-Induced Effects on Oscillations, N170 Visual-Evoked Potentials, and Visual Hallucinations Journal of Neuroscience June 19, 2013
- Dreamlike effects of LSD on waking imagery in humans depend on serotonin 2A receptor activation Psychopharmacology July 1, 2017