Bath salts made me catatonic but the wrong diagnosis made my symptoms even worse
A teenager who took bath salts in the Alps was left in a catatonic state for over a month – unable to move or speak.
The 17-year-old had taken a small tablet while on vacation that police later confirmed was ‘bath salts,’ a synthetic stimulant that can cause euphoria and alertness, as well as aggression, violence, paranoia, and hallucinations.
She hallucinated and became confused on the drug. When it was leaving her system, symptoms devolved into severe anxiety and depression.
A week later, she went to the hospital anxious, confused, and dissociated, having not slept in days. She had poor balance, slurred speech, and difficulty speaking.
Doctors believed the girl had suffered a psychotic break and began a regimen of antipsychotic medication, which blocks dopamine receptors in the brain.
Excess dopamine is believed to cause hallucinations, delusions, and disjointed thinking characteristic of psychosis.
But her condition worsened and eventually she stopped talking altogether, a condition called mutism. She did not respond to doctors’ requests or instructions (called negativism), went limp when doctors tried to move her and refused to eat, requiring a feeding tube.
While doctors did not recognize it at the time, their patient had developed catatonia, a life-threatening mental health condition that can lead to blood clots from prolonged lack of movement, as well as malnutrition, dehydration, muscle breakdown, and kidney damage.
The teenage patient went into a catatonic state about 24 hours after taking what police later confirmed was ‘bath salts’, a synthetic stimulant known to cause alterness and aggression as well as symptoms of psychosis (stock photo)
As a result, she developed deep vein thrombosis, a blood clot that forms in a deep vein in the body, usually in the lower leg or thigh. The clot can travel through the bloodstream and make its way to the lungs, blocking blood flow. This can lead to a life-threatening pulmonary embolism.
Bath salts flood the brain with dopamine, the neurotransmitter most closely associated with pleasure, reward, and motivation, as well as motor control.
Too much dopamine, though, can lead to hallucinations and paranoia, both symptoms of psychosis.
When she first entered the hospital, doctors believed she was in the midst of a psychotic break as a result of the drugs.
Initially, she was treated with risperidone (an antipsychotic), which was then stopped when her condition worsened to the point at which she needed a feeding tube because she could not eat and stopped talking.
When she developed a blood clot as a result of moving very little or not at all for about two weeks in the hospital, doctors moved her to the medical wing of the hospital for treatment.
Once there, they revisited her psychiatric assessment and administered a screening tool for catatonia called the Bush-Francis Catatonia Rating Scale.
She scored high for immobility, mutism, empty staring, unusual posture, and negativism, all signs of catatonia.
They removed risperidone from her medication regimen and believed adding lorazepam (a anti-anxiety drug) would help her symptoms, but it wasn’t fully effective even at a high dose.
Then, they briefly tried olanzapine (a second antipsychotic), but her condition continued to decline, with worsening symptoms.
She described a feeling of living in a dream, as if in ‘The Sims’ game.
Eventually, as her catatonic symptoms worsened, doctors took her off antipsychotics altogether. When they kept her on the benzodiazepine, though, she improved.
While she had never sought professional treatment for a mental health issue, she had a family history of bipolar one disorder marked by high-energy manic episodes for a week or more, followed by episodes of depression for at least two weeks.
Doctors began giving her medications that together treat bipolar – lithium and memantine. They followed up with her, though the case report does not say how long after her discharge, and she was still doing well.
According to her medical case report, after two weeks, she left the hospital, and a week after that, she recovered completely.
Catatonia from drug withdrawal is more often seen in people who take drugs regularly for months or years and suddenly stop.
But in this patient’s case, her health crumbled after taking drugs just once, a result of a ‘malicious unrecognized consequence of newer dirty designer drugs, such as “bath salts,”’ as well as genetic predisposition.
