Is Namenda (Memantine) Used for Catatonia?
Yes, memantine (Namenda) is used as an alternative or adjunctive treatment for catatonia, particularly when benzodiazepines fail or are contraindicated, or when electroconvulsive therapy (ECT) is unavailable or ineffective. 1
Evidence for Memantine in Catatonia
While memantine is FDA-approved for moderate to severe dementia 2, emerging evidence supports its off-label use in catatonia through NMDA receptor antagonism:
Clinical Evidence Base
A 2024 narrative review identified 20 cases across 14 articles demonstrating memantine's efficacy in catatonia, typically used alone or combined with lorazepam, with rapid responses observed 1
Memantine has proven effective in ECT-resistant catatonia, including a case of a 52-year-old male with schizophrenia where catatonia resolved after memantine titration despite failed lorazepam and robust ECT trials 3
The mechanism involves glutamate NMDA receptor antagonism, addressing the hypothesized NMDA hyperactivity contributing to catatonic syndromes 4
Clinical Scenarios for Use
Memantine should be considered when:
- Benzodiazepines produce partial or no response to standard dosing 1
- ECT is unavailable, not tolerated, or has failed to achieve full symptom resolution 1, 3
- Co-morbid delirium exists where benzodiazepines may be contraindicated 1
- Chronic catatonia persists, particularly in patients with primary psychotic disorders like schizophrenia 3
Pediatric Use
- Memantine has been safely used in adolescent catatonia as an adjunctive agent, though pediatric data remains limited 5
- A 16-year-old achieved full remission using combined benzodiazepines, ECT, and memantine when conventional therapies stagnated 6
Important Caveats
This is an off-label use - memantine's FDA approval is limited to dementia treatment 2, not catatonia. The evidence base consists primarily of case reports and case series rather than randomized controlled trials 1, 4.
Reconsider the diagnosis if standard treatments fail, and optimize ECT parameters before adding memantine 3.
Use cautiously with antipsychotics, as these may worsen catatonia in some cases 3.