CASE REPORT article
Front. Psychiatry
Sec. Public Mental Health
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1688633
This article is part of the Research TopicBridging the Gap: An Interdisciplinary Perspective on Ketamine in Psychiatric Disorders - Volume IIIView all 4 articles
Low-dose intravenous esketamine on a depressive catatonia patient with venous thromboembolism: a case report
Provisionally accepted
- Beijing Anding Hospital, Capital Medical University, Beijing, China
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Background Catatonia is a rare but potentially life-threatening psycho-motor syndrome. It is mainly manifested as decreased activities, or excessive and specific activities, such as stupor, agitation and defiance. Catatonia can appear in various diseases and the diagnosis and treatment of depressive catatonia are often delayed. As an N-methyl-D-aspartate (NMDA) receptor antagonist, esketamine shows antidepressant and anti-catatonic effects by regulating glutamatergic signal transduction and enhancing synaptic plasticity. Methods The present case involved a 55-year-old woman with depressive catatonia. Benzodiazepines, aripiprazole and nutritional support were given after admission. As she had a poor response to the initial treatment, we considered using the modified electroconvulsive therapy (MECT). Due to the deep vein thrombosis in the lower extremities, the application of MECT was restricted. With the consent of her and family, we decied to administrate a sub-anesthetic dose of intravenous (IV) Esketamine (0.2 mg/Kg) combined with 50mg desvenlafaxine. During the process, we assessed the effect by comparing depression severity scores using validated psychiatric scales before and after the treatment. Adverse drug reactions were evaluated by adverse drug reaction scale. Result The symptoms of catatonia were relieved in 4 hours after esketamine administration. The Bush-Francis Catatonia Rating Scale (BFCRS) decreased from 19 to 0. 48 hours after injection, the depressive symptoms were relieved and the Montgomery Åsberg Depression Rating Scale (MADRS) decreased from 46 to 9. The condition remained stable on 20 weeks of follow-up. Conclusions As a safe and rapid intervention, Esketamine might be a new option for catatonic patients who cannot undergo MECT or fail to respond to conventional treatment. It may be worthy of further research in the future.
Keywords: Catatonia, Major Depressive Disorder, Esketamine, N-methyl-D-aspartate receptor antagonist, Venousthromboembolism
Received: 19 Aug 2025; Accepted: 21 Oct 2025.
Copyright: © 2025 JI, Zhang, Wang, Li and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xiao JI, xiaoqixuan@icloud.com
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