Clonazepam for Catatonia Incompletely Responsive to Lorazepam

Purpose Benzodiazepines (BZDs) are a mainstay of treatment of catatonia with response rates of 60 to 80%, but there is virtually no data regarding the relative efficacy of different agents. We report a patient with catatonia who responded incompletely to lorazepam but much more definitively to clonazepam. Procedures Single case report. Findings A 74 year old man with recurrent catatonia had responded only partially to lorazepam and to a number of other interventions. He was ultimately treated with clonazepam monotherapy and exhibited a much more robust response. Conclusions In this patient, clonazepam may have proved more effective than lorazepam due to its higher affinity for the BZD binding site of the GABAA receptor or possibly due to its longer half life or intrinsic serotonergic activity. It may be reasonable to consider clonazepam in a patient whose response to other BZDs has been incomplete, but this remains to be confirmed in controlled studies.