Depresión psicótica y catatonía crónica resistentes a terapia electroconvulsiva. Descripción de un caso de tratamiento con ketamina
- Nora Olazabal Eizaguirre
- Sonia Bustamante Madariaga
- Luis Osa Fernández
- Arantzazu Madrazo Maza
- Ana Catalán Alcántara
- Lorea Larrañaga Rementeria
- Aída Díaz Cosgaya
- Gerardo Priego Rementeria
- Miguel Ángel González-Torres
ISSN: 1134-5934
Year of publication: 2016
Volume: 23
Issue: 1
Pages: 36-39
Type: Article
More publications in: Psiquiatría biológica: Publicación oficial de la Sociedad Española de Psiquiatría Biológica
Abstract
In this paper we are going to present the case of a patient with major depression with psychotic features and a chronic-course catatonic syndrome that was resistant to psychopharmacological treatment. Treatment was started with electroconvulsive therapy and benzodiazepines, and, after an initial favourable response, it subsequently became refractory. It was decided to treat it with intravenous ketamine infusions, which is among the available therapeutic options for the treatment of resistant depression. The glutamatergic effect of ketamine is responsible for its rapid-onset therapeutic action. As an oral maintenance pharmacological treatment, it was decided to use drugs with similar pharmacological mechanisms of action (lithium, lamotrigine, clozapine, TCA). The chronic nature of the catatonic syndrome creates changes in neurotransmission patterns, which become structural patterns that are difficult to modify. Chronic depression is a neurotoxic condition and damages the microvasculature of the brain, as evidenced in white matter lesions which are irreversible. An early detection and correct treatment of catatonic syndromes continues to be a priority in our clinical practice.