Clozapine-Memantine Therapy in Catatonia: Clinical Insights From a Case Report and Literature Review.

OBJECTIVES

To present a case of catatonia in a patient with schizophrenia successfully managed with clozapine and memantine in the absence of standard treatment options. A focused literature review was also conducted to contextualize the findings within the existing evidence.

METHODS

A 26-year-old man with schizophrenia presented with classic catatonic symptoms, including mutism, posturing, and negativism. Although a lorazepam challenge confirmed benzodiazepine responsiveness, further use was limited by drug unavailability, and electroconvulsive therapy (ECT) was contraindicated due to a cerebral aneurysm. Clozapine was initiated and titrated to 450 mg/d, followed by adjunctive memantine up to 20 mg/d. Clinical progression was assessed with the Bush-Francis Catatonia Rating Scale (BFCRS).

RESULTS

Clozapine treatment led to progressive improvement in motor and verbal functions, followed by accelerated recovery after the addition of memantine. Full remission (BFCRS = 0) was achieved by day 42, with complete functional recovery and sustained stability at the 1-month follow-up. Treatment was well-tolerated without adverse effects. Our focused review of the literature indicated that most reported clozapine-treated catatonia cases involved concomitant benzodiazepines and/or ECT, whereas reports of treatment without these standard interventions were uncommon. Reports describing combined clozapine-memantine treatment were particularly rare.

CONCLUSIONS

This case demonstrates that clozapine can serve as a viable alternative treatment for catatonia when standard interventions are unavailable or contraindicated. Memantine may offer additional therapeutic benefits; however, further research is required to establish its efficacy. The rarity of similar cases in the literature further highlights the uniqueness of the present clinical scenario.