The finding:
The review highlights the promising potential of ketamine as a treatment for catatonia, achieving an 80% response rate and a 44% remission rate across the studies included. Ketamine was most effective in patients with mood disorders, demonstrating higher rates of improvement compared to those with psychotic disorders. Administration was typically intravenous, often in subanesthetic doses over 40 minutes, and resulted in rapid symptom relief for many patients. Notably, ketamine proved effective in patients refractory to benzodiazepines and electroconvulsive therapy (ECT), suggesting its utility as an alternative in challenging cases. The review also found that adverse effects were generally minimal and did not worsen catatonic symptoms, supporting ketamine’s safety profile in this population.

Strength and weaknesses:
The article presents a comprehensive review of available studies using a systematic methodology, and it includes diverse patient populations and contexts. The evidence suggests that ketamine could offer rapid and effective relief, particularly for mood-related catatonia. However, the study has several weaknesses, including a limited sample size of only 25 patients, with a high reliance on case reports. The study designs are heterogeneous, and there is variable reporting on treatment protocols and outcomes. The absence of randomized controlled trials and standardized scales further limits the generalizability of the findings.

Relevance:
The findings are highly relevant for consultation-liaison psychiatrists who frequently manage catatonia in medical settings. Ketamine may offer an alternative treatment for patients refractory to benzodiazepines or electroconvulsive therapy (ECT). Moreover, its utility in cases where ECT is contraindicated or unavailable could address significant treatment gaps. Further research could solidify its role as part of the standard therapeutic arsenal for catatonia.