A systematic review of case reports and case series of zolpidem in the diagnosis and treatment of catatonia
Niraj Ahuja, Harry Hackett, Joseph Thorne, Stuart Watson, Richard Hamish McAllister-WilliamsBackground
Catatonia, commonly seen in psychiatric and medical practice, is often associated with increased morbidity and mortality. The neurotransmitter systems involved in catatonia include GABA, dopamine and glutamate. Benzodiazepines such as lorazepam, which act on GABA-A receptors, are used to confirm the diagnosis of catatonia, and are the mainstay of treatment. However, several patients with catatonia either don’t respond to lorazepam or its use is not suitable or possible (e.g. due to supply issues). Zolpidem is a positive allosteric modulator of GABA-A receptors. There are an increasing number of case reports and one systematic review of its use in the diagnosis and treatment of catatonia.
Objectives
The objective of this systematic review is to explore the published evidence of zolpidem’s efficacy as a diagnostic test and for treatment for catatonia.
Design, data sources and methods
We systematically reviewed evidence for zolpidem use in diagnosis and/or treatment of catatonia, using the PRISMA guidelines. We identified 44 case reports and case series, with 79 patients who met the inclusion criteria through searches of PubMed, Medline, EMBASE, CINAHL, ProQuest and PsycInfo.
Results
67 out of 79 patients (84.8%) with catatonia showed a positive response to zolpidem, with remission of catatonic symptoms in 24.1% of patients. The high response rate was evident regardless of its use as a challenge test (85.7%) or treatment (86.1%), either used alone (85.7%), or with a benzodiazepine (81.3%). The mean dose of zolpidem was 14.7mg, with a median of 10mg, and a range of 5 to 45mg, with a rapid mean time to response of 30.2 minutes. A few patients responded better to zolpidem at a higher dose and/or when used over a longer duration though this was not always the case. The response rate was higher in women (88.6%) as compared to men (64.7%).
Conclusions
Although the results from this systematic review generate optimism for the use of zolpidem in diagnosis and treatment of catatonia, these results should be used with caution as there are no randomised controlled trials of zolpidem compared to placebo and/or lorazepam.