Is memantine (Namenda) used in psychiatry?

From the Guidelines

Memantine is indeed used in psychiatry, primarily for the treatment of moderate to severe Alzheimer's disease, as evidenced by high-quality studies such as 1 and 1.

Key Points

• Memantine works by blocking NMDA glutamate receptors in the brain, which helps regulate glutamate activity that can be excessive and harmful in Alzheimer's disease.
• The typical starting dose is 5 mg once daily, gradually increasing to a target dose of 10 mg twice daily over several weeks to minimize side effects, as seen in studies like 1.
• Beyond its FDA-approved use for Alzheimer's, memantine is sometimes prescribed off-label for other psychiatric conditions including treatment-resistant depression, obsessive-compulsive disorder, and certain types of dementia with behavioral disturbances.
• Patients should be aware that common side effects include dizziness, headache, confusion, and constipation, as reported in studies such as 1.
• Memantine is generally well-tolerated compared to cholinesterase inhibitors (another class of Alzheimer's medications) and can be used alone or in combination with these medications for enhanced therapeutic effect in Alzheimer's disease, as noted in 1 and 1.

Evidence Summary

• A pooled estimate from 3 trials showed that memantine resulted in statistically significant, but not clinically important, improvement on the ADAS-cog scale in cognition for individuals with mild to moderate vascular dementia and mild to moderate Alzheimer disease, as seen in 1.
• Summary estimates demonstrated statistically significant change on the CIBIC-plus scale for patients with all levels of severity of Alzheimer disease and vascular dementia with the 20-mg dose, as reported in 1.
• Three of 4 studies that evaluated quality of life found statistically significant improvements, and the summary estimate was statistically significant, as noted in 1.

From the FDA Drug Label

Memantine hydrochloride is an N-methyl-D-aspartate (NMDA) receptor antagonist indicated for the treatment of moderate to severe dementia of the Alzheimer’s type. The answer is no, memantine is not used in psychiatry, it is used for the treatment of moderate to severe dementia of the Alzheimer’s type 2.

From the Research

Use of Memantine in Psychiatry

• Memantine is used in the treatment of various psychiatric disorders, including:
  • Major neuro-cognitive disorder due to Alzheimer's disease and severe vascular dementia 3
  • Obsessive-compulsive disorder 3, 4
  • Treatment-resistant schizophrenia 3, 4
  • Attention-deficit hyperactivity disorder (ADHD) 3
• Modicum evidence supports the use of memantine for:
  • Post-traumatic stress disorder (PTSD) 3, 4
  • Generalized anxiety disorder (GAD) 3, 4
  • Pathological gambling 3, 4
• Less compelling evidence is present for the use of memantine in:
  • Catatonia 3, 4
• No evidence supports the use of memantine for:
  • Core symptoms of autism spectrum disorder 3
• Memantine has been studied in other psychiatric disorders, including:
  • Depression 5, 4
  • Bipolar disorder 4
  • Substance and alcohol abuse/dependence 4
  • Eating disorders 4
  • Impulse control disorders 4
  • Anxiety disorders 4