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Rapid efficacy of aripiprazole in the treatment of catatonic depression/catatonia with consideration of the drug's unique receptor profile: a case report.
Fortschr Neurol Psychiatr. 2020 Jun 23 [Online ahead of print]FN

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.

Authors+Show Affiliations

Krankenhaus für Psychiatrie Psychotherapie und Psychosomatische Medizin Schloss Werneck.Krankenhaus für Psychiatrie Psychotherapie und Psychosomatische Medizin Schloss Werneck.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32575133

Citation

Sichert, Verena, and Hans-Peter Volz. "Rapid Efficacy of Aripiprazole in the Treatment of Catatonic Depression/catatonia With Consideration of the Drug's Unique Receptor Profile: a Case Report." Fortschritte Der Neurologie-Psychiatrie, 2020.
Sichert V, Volz HP. Rapid efficacy of aripiprazole in the treatment of catatonic depression/catatonia with consideration of the drug's unique receptor profile: a case report. Fortschr Neurol Psychiatr. 2020.
Sichert, V., & Volz, H. P. (2020). Rapid efficacy of aripiprazole in the treatment of catatonic depression/catatonia with consideration of the drug's unique receptor profile: a case report. Fortschritte Der Neurologie-Psychiatrie. https://doi.org/10.1055/a-1183-3887
Sichert V, Volz HP. Rapid Efficacy of Aripiprazole in the Treatment of Catatonic Depression/catatonia With Consideration of the Drug's Unique Receptor Profile: a Case Report. Fortschr Neurol Psychiatr. 2020 Jun 23; PubMed PMID: 32575133.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rapid efficacy of aripiprazole in the treatment of catatonic depression/catatonia with consideration of the drug's unique receptor profile: a case report. AU - Sichert,Verena, AU - Volz,Hans-Peter, Y1 - 2020/06/23/ PY - 2020/6/24/entrez PY - 2020/6/24/pubmed PY - 2020/6/24/medline JF - Fortschritte der Neurologie-Psychiatrie JO - Fortschr Neurol Psychiatr N2 - 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. SN - 1439-3522 UR - https://www.unboundmedicine.com/medline/citation/32575133/Rapid_efficacy_of_aripiprazole_in_the_treatment_of_catatonic_depression/catatonia_with_consideration_of_the_drug's_unique_receptor_profile:_a_case_report L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/a-1183-3887 DB - PRIME DP - Unbound Medicine ER -
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