Rapid efficacy of aripiprazole in the treatment of catatonic depression/catatonia with consideration of the drug’s unique receptor profile: a case report

Abstract

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.

Aparente respuesta rápida a la combinación de zolpidem, memantina y aripiprazol en un caso de catatonía esquizofrénica

“…El aripiprazol, por su efecto de bloqueo 5HT 1A y agonismo 5HT 2A , puede estimular la liberación de dopamina en el córtex prefrontal, además de incrementar la transmisión gabaérgica en dicha zona (16). Su perfil único de agonista parcial dopaminérgico parece ser crucial, además de su escasa afinidad intrínseca por el receptor D2, en su efectividad sobre catatonía.…”

Use of the Third-Generation Atypical Antipsychotic Aripiprazole (Zylaxera®) for Treatment of Depressive States in Schizophrenia: Efficacy and Safety Study

“…В другом наблюдении отмечен положительный опыт монотерапии арипипразолом в случае стойких и дезадаптирующих руминаций у пациента с непсихотической депрессией [51]. Описан случай быстрого разрешения кататонии в рамках монополярной депрессии на фоне лечения арипипразолом [52]. Также сообщается о нескольких случаях редукции проявлений деперсонализации в рамках депрессии, которые обычно тяжело поддаются фармакологическому лечению [53].…”