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I found an old paper describing a case study where a catatonic patient was successfully treated with benztropine (Cogentin). However, I can't find any modern guidelines that calls for this treatment (first-line is usually benzodiazepams). Is there any reason not to use anticholinergics for catatonia treatment?

Sources:

  1. Albucher RC, DeQuardo J, Tandon R. Treatment of catatonia with an anticholinergic agent. Biol Psychiatry. 1991;29(5):513-514. doi:10.1016/0006-3223(91)90281-p
  2. Francis A. Catatonia: diagnosis, classification, and treatment. Curr Psychiatry Rep 2010; 12:180.
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Anticholinergics by themselves commonly have sedative effects. The reason you read about benztropine being used is that it has dopaminergic activity as well (in addition to anticholinergic activity). Specifically, benztropine and its derivatives are also dopamine reuptake inhibitors.

So from the perspective that benztropine is a dopamine reuptake inhibitor, i.e. a stimulant in the traditional sense, it would probably be a bad idea to use as a treatment for catatonia. If I remember right, its particular binding affinity is significant at the dopamine transporter.

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