Brain balancing GABA and glutamate with ECT fading as a new treatment arises.

Catatonia Breakthrough: How Acamprosate Offers Hope When ECT Falls Short

Mira Elwood in Health & Wellness November 2025 • 4 min read.

"Exploring a novel treatment approach for catatonia in frontotemporal dementia (FTD) using acamprosate to sustain recovery after initial ECT response."

Frontotemporal dementia (FTD), often representing 10-15% of dementia cases, poses significant challenges in diagnosis and treatment. As the third most prevalent neurodegenerative cortical dementia, following Alzheimer's and Lewy body dementia, FTD equally affects men and women, typically between 45 and 65 years old. Its early symptoms involve subtle behavioral and personality changes, which can be difficult to distinguish from other psychiatric conditions.

Catatonia, characterized by a range of motor and behavioral disturbances, frequently complicates the presentation of dementia, including FTD. Diagnosing catatonia in dementia patients can be challenging due to overlapping symptoms, often leading to underdiagnosis. While treatments like lorazepam and electroconvulsive therapy (ECT) are typically effective, their benefits can be short-lived or accompanied by significant side effects, necessitating alternative strategies.

Recent research highlights the potential of acamprosate, a medication primarily used to treat alcoholism, in managing catatonia associated with FTD. A case study demonstrated that acamprosate effectively sustained recovery in a patient with catatonic FTD after initial ECT response waned. This article explores this innovative treatment approach, offering hope for improved management of complex neuropsychiatric cases.

Acamprosate: A Novel Approach to Sustaining Catatonia Relief

Brain balancing GABA and glutamate with ECT fading as a new treatment arises.

Catatonia's underlying neurobiology points to cortical GABA deficiency and glutamate excitotoxicity. This understanding has led to the use of benzodiazepines and ECT as primary treatments, irrespective of the cause. However, clinicians often hesitate to use these "aggressive" methods on frail, demented patients due to potential side effects and concerns about tolerability.

Acamprosate, known for its anti-craving effects in alcoholism, acts as an NMDA-glutamate antagonist and enhances GABAa activity. This dual action makes it a promising candidate for addressing the neurobiological imbalances in catatonia. Its safety profile, with minimal impact on the hepatic microsomal system, makes it particularly attractive for older patients with cognitive impairments.

GABA Deficiency: Catatonia often involves reduced levels of GABA, an inhibitory neurotransmitter in the brain.
Glutamate Excitotoxicity: Excessive glutamate activity can lead to neuronal damage and contribute to catatonic symptoms.
Acamprosate Mechanism: By modulating GABA and glutamate, acamprosate helps restore balance in brain activity.
ECT Limitations: While effective, ECT's benefits can be temporary, and it may have cognitive side effects.
Safety Profile: Acamprosate is generally well-tolerated, with fewer risks for elderly patients compared to other treatments.

Consider a case of a 59-year-old male diagnosed with FTD, who had developed catatonia, displayed symptoms such as sluggish psychomotor activity, muteness, resistance, negativism, stereotypies, and paratonia. Initial treatment with lorazepam confirmed the presence of catatonia, and ECT was initiated. After five sessions of modified bitemporal ECT, the patient showed improvement, but the effects were short-lived.

The Future of Catatonia Treatment

The successful use of acamprosate in this case opens new possibilities for catatonia treatment, especially for patients who do not respond well to first-line treatments or cannot tolerate their side effects. More research is needed through well-designed clinical trials to fully understand the potential of acamprosate in catatonia management and to refine treatment protocols. This case offers a promising step forward in improving the care and quality of life for individuals with catatonic FTD.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.4172/2378-5756.1000292, Alternate LINK

Title: Acamprosate Complements Ill-Sustained Response Of Ect In Catatonic Frontotemporal Dementia

Subject: General Engineering

Journal: Journal of Psychiatry

Publisher: OMICS Publishing Group

Authors: Ahmed Naguy

Published: 2015-01-01

Everything You Need To Know

What is Catatonia and how does it relate to Frontotemporal Dementia (FTD)?

Catatonia is a neuropsychiatric syndrome characterized by motor and behavioral disturbances. In the context of Frontotemporal Dementia (FTD), catatonia often complicates the presentation of the dementia. FTD, a neurodegenerative disorder affecting the frontal and temporal lobes, can present with catatonic symptoms, which makes the diagnosis complex due to overlapping symptoms. It's important to note that FTD accounts for a significant portion of dementia cases, and catatonia can severely impact the quality of life for those affected by FTD.

How does Acamprosate work in treating Catatonia, and why is it considered a novel approach?

Acamprosate, primarily used for alcoholism, is a novel treatment for catatonia because it addresses the underlying neurobiological imbalances. Its mechanism involves acting as an NMDA-glutamate antagonist and enhancing GABAa activity. The neurobiology of catatonia is linked to cortical GABA deficiency and glutamate excitotoxicity. Acamprosate's dual action helps restore balance in brain activity by modulating both GABA and glutamate, offering a different approach than traditional treatments like lorazepam and electroconvulsive therapy (ECT).

What are the limitations of Electroconvulsive Therapy (ECT) in treating Catatonia associated with FTD?

While Electroconvulsive Therapy (ECT) is an effective treatment for catatonia, its benefits can be short-lived. Furthermore, ECT may come with cognitive side effects. In the context of Frontotemporal Dementia (FTD), patients are often frail and elderly, making the side effects and aggressive nature of ECT a concern. Therefore, alternative strategies are needed to provide sustained relief without the drawbacks associated with ECT. Acamprosate offers an alternative that may extend the benefits from ECT in some cases.

Why is the safety profile of Acamprosate advantageous for elderly patients with dementia?

Acamprosate's safety profile is particularly attractive for elderly patients with dementia because it has minimal impact on the hepatic microsomal system. This is a significant advantage because many other treatments, like benzodiazepines and even Electroconvulsive Therapy (ECT), can have more significant side effects. The ability of Acamprosate to be well-tolerated reduces risks for older patients who may also have other health issues and cognitive impairments.

Can you describe a specific example of a patient who was treated with Acamprosate for Catatonia?

A 59-year-old male diagnosed with Frontotemporal Dementia (FTD) developed catatonia, exhibiting sluggish psychomotor activity, muteness, resistance, negativism, stereotypies, and paratonia. Initially, lorazepam confirmed the presence of catatonia, and Electroconvulsive Therapy (ECT) was initiated. After five sessions of modified bitemporal ECT, the patient improved temporarily. When the effects of ECT waned, Acamprosate was then used to successfully sustain recovery. This case illustrates the potential of Acamprosate in extending the benefits of ECT, particularly when the initial response to ECT is not long-lasting.