Ketamine for Resistant Catatonia: A Promising New Avenue: PsyQ Episode 19

In this episode we’ll orient listeners to catatonia’s core features and standard pathways (lorazepam → ECT), then pivot to emerging third-line options when Ativan is ineffective and ECT isn’t feasible. Using a recent systematic review and a bipolar-catatonia case report as anchors, we’ll cover why NMDA antagonism makes mechanistic sense, dosing patterns (most reports used 0.5 mg/kg IV over ~40 min, often as a short series), and what the aggregate signals show: ~80% response and ~44% remission across published cases, with no reported worsening of catatonia or psychosis and only one discontinuation for dissociation. We’ll also highlight real-world scenarios where ketamine helped patients who were medically unfit for ECT (e.g., cardiomyopathy, advanced lung disease) and improved within hours to days—illustrating ketamine’s potential role as a bridge or alternative in treatment-resistant catatonia, especially in mood-disorder presentations. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit upathak.substack.com