Memantine leading to physical aggression in the treatment of chronic catatonia secondary to schizophrenia: A case report
Introduction Memantine is a noncompetitive N-methyl-D-aspartate receptor antagonist approved by the FDA for moderate to severe Alzheimer’s dementia. Memantine is also recommended as an off-label treatment in current catatonia clinical guidelines when benzodiazepines alone are inadequate. Case A 37-y...
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| Language: | English |
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American Association of Psychiatric Pharmacists
2025-08-01
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| Series: | Mental Health Clinician |
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| Online Access: | https://theijpt.org/doi/pdf/10.9740/mhc.2025.08.218 |
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| author | Andrew Chantha Hean, PharmD Jessica Jones, PharmD Michael Arena, MD Kevin Kavanagh, PharmD |
| author_facet | Andrew Chantha Hean, PharmD Jessica Jones, PharmD Michael Arena, MD Kevin Kavanagh, PharmD |
| author_sort | Andrew Chantha Hean, PharmD |
| collection | DOAJ |
| description | Introduction
Memantine is a noncompetitive N-methyl-D-aspartate receptor antagonist approved by the FDA for moderate to severe Alzheimer’s dementia. Memantine is also recommended as an off-label treatment in current catatonia clinical guidelines when benzodiazepines alone are inadequate.
Case
A 37-year-old male with a history of schizophrenia on psychiatric conservatorship, stimulant use disorder, and traumatic brain injury was stabilized on risperidone 4 mg twice daily, diphenhydramine 50 mg twice daily, divalproex delayed release 500 mg twice daily, and lorazepam 1 mg twice daily for catatonia. Lorazepam was titrated for unresolved chronic catatonic symptoms but was not tolerated beyond 5 mg total per day due to hemodynamic instability. Owing to barriers in initiating clozapine or electroconvulsive therapy, the patient was started on memantine to address residual catatonia symptoms. After the addition of memantine, the patient began to spontaneously speak in multiple languages and engage in discharge planning, but shortly after a dose increase to 15 mg daily also displayed increased aggressive behaviors. The aggression improved after decreasing the dose to 10 mg daily, and the patient was discharged.
Conclusions
This case adds to the body of evidence for memantine in catatonia with underlying schizophrenia and, to our knowledge, is the first described case of memantine uncovering aggression during catatonia treatment. |
| format | Article |
| id | doaj-art-0d1fbff8dc02402ab595ff14795f21fb |
| institution | Kabale University |
| issn | 2168-9709 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | American Association of Psychiatric Pharmacists |
| record_format | Article |
| series | Mental Health Clinician |
| spelling | doaj-art-0d1fbff8dc02402ab595ff14795f21fb2025-08-23T16:55:39ZengAmerican Association of Psychiatric PharmacistsMental Health Clinician2168-97092025-08-0115421822110.9740/mhc.2025.08.218i2168-9709-15-4-218Memantine leading to physical aggression in the treatment of chronic catatonia secondary to schizophrenia: A case reportAndrew Chantha Hean, PharmD0https://orcid.org/0000-0002-8340-2296Jessica Jones, PharmD1https://orcid.org/0000-0002-6002-7219Michael Arena, MD2https://orcid.org/0009-0005-4979-0554Kevin Kavanagh, PharmD3https://orcid.org/0000-0002-9359-97901 (Corresponding author) Assistant Professor of Pharmacy Practice and Administration, Western University of Health Sciences, College of Pharmacy, Pomona, California2 Behavioral Health Pharmacy Specialist, Department of Pharmacy, Sharp Grossmont Hospital, San Diego, California3 Attending Psychiatrist, San Diego County Psychiatric Hospital, County of San Diego Health and Human Services Agency, San Diego, California4 Clinical Pharmacist, San Diego County Psychiatric Hospital, County of San Diego Health and Human Services Agency, San Diego, CaliforniaIntroduction Memantine is a noncompetitive N-methyl-D-aspartate receptor antagonist approved by the FDA for moderate to severe Alzheimer’s dementia. Memantine is also recommended as an off-label treatment in current catatonia clinical guidelines when benzodiazepines alone are inadequate. Case A 37-year-old male with a history of schizophrenia on psychiatric conservatorship, stimulant use disorder, and traumatic brain injury was stabilized on risperidone 4 mg twice daily, diphenhydramine 50 mg twice daily, divalproex delayed release 500 mg twice daily, and lorazepam 1 mg twice daily for catatonia. Lorazepam was titrated for unresolved chronic catatonic symptoms but was not tolerated beyond 5 mg total per day due to hemodynamic instability. Owing to barriers in initiating clozapine or electroconvulsive therapy, the patient was started on memantine to address residual catatonia symptoms. After the addition of memantine, the patient began to spontaneously speak in multiple languages and engage in discharge planning, but shortly after a dose increase to 15 mg daily also displayed increased aggressive behaviors. The aggression improved after decreasing the dose to 10 mg daily, and the patient was discharged. Conclusions This case adds to the body of evidence for memantine in catatonia with underlying schizophrenia and, to our knowledge, is the first described case of memantine uncovering aggression during catatonia treatment.https://theijpt.org/doi/pdf/10.9740/mhc.2025.08.218memantinecatatoniabenzodiazepinerefractoryschizophrenia |
| spellingShingle | Andrew Chantha Hean, PharmD Jessica Jones, PharmD Michael Arena, MD Kevin Kavanagh, PharmD Memantine leading to physical aggression in the treatment of chronic catatonia secondary to schizophrenia: A case report Mental Health Clinician memantine catatonia benzodiazepine refractory schizophrenia |
| title | Memantine leading to physical aggression in the treatment of chronic catatonia secondary to schizophrenia: A case report |
| title_full | Memantine leading to physical aggression in the treatment of chronic catatonia secondary to schizophrenia: A case report |
| title_fullStr | Memantine leading to physical aggression in the treatment of chronic catatonia secondary to schizophrenia: A case report |
| title_full_unstemmed | Memantine leading to physical aggression in the treatment of chronic catatonia secondary to schizophrenia: A case report |
| title_short | Memantine leading to physical aggression in the treatment of chronic catatonia secondary to schizophrenia: A case report |
| title_sort | memantine leading to physical aggression in the treatment of chronic catatonia secondary to schizophrenia a case report |
| topic | memantine catatonia benzodiazepine refractory schizophrenia |
| url | https://theijpt.org/doi/pdf/10.9740/mhc.2025.08.218 |
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