A longitudinal case series of IM ketamine for patients with severe and enduring eating disorders and comorbid treatment‐resistant depression

Schwartz, Terry Ann; Trunko, Mary Ellen; Feifel, David; Lopez, Emily; Peterson, Danika; Frank, Guido; Kaye, Walter H.

doi:10.1002/ccr3.3869

Cited by 31 publications

(35 citation statements)

References 13 publications

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“…The findings are described in detail and organized in relation to the specific type of article and order of publication (see Table 1). Studies retrieved were represented by nine case series/case reports [13,[40][41][42][43][44][45][46][47][48], six randomized-controlled trials [49][50][51][52][53][54], ten open-label studies [55][56][57][58][59][60][61][62][63][64][65] and three double blind trials [66][67][68]. Most cases involved adult males (total M/F = 328/160= 2.1).…”

Section: Resultsmentioning

confidence: 99%

“…Most cases involved adult males (total M/F = 328/160= 2.1). Patients were mostly diagnosed with OCD [13,40,45,47,55,56,[60][61][62][63][64] or a SUD, such as opioid dependence [41,[43][44][45][46][57][58][59], cocaine dependence [49,50,52,[66][67][68] or alcohol dependence [51,54,65]. Only three studies focused on ED [42,46,48].…”

Section: Resultsmentioning

confidence: 99%

“…Patients were mostly diagnosed with OCD [13,40,45,47,55,56,[60][61][62][63][64] or a SUD, such as opioid dependence [41,[43][44][45][46][57][58][59], cocaine dependence [49,50,52,[66][67][68] or alcohol dependence [51,54,65]. Only three studies focused on ED [42,46,48]. Ketamine was mostly intravenously administered [42][43][44][45][47][48][49][50][51][52][53][54][55][56][57][59][60][61][65]…”

Section: Resultsmentioning

confidence: 99%

“…Only three studies focused on ED [42,46,48]. Ketamine was mostly intravenously administered [42][43][44][45][47][48][49][50][51][52][53][54][55][56][57][59][60][61][65][66][67], but intranasal [40,62], intramuscular [46,58,68] and oral [13,41] routes of administration were also recorded. Ketamine was administered together with Cognitive Behavioral Therapy (CBT) [40,43], or in the context of ketamine-assisted psychotherapy (KPT) sessions [58,68] or Trauma Interventions using Mindfulness Based Extinction and Reconsolidation of memories (TIMBER) [59].…”

Section: Resultsmentioning

confidence: 99%

“…Ketamine was administered together with Cognitive Behavioral Therapy (CBT) [40,43], or in the context of ketamine-assisted psychotherapy (KPT) sessions [58,68] or Trauma Interventions using Mindfulness Based Extinction and Reconsolidation of memories (TIMBER) [59]. Ketamine was generally well tolerated, with the exception of transient effects, including nausea [42,43], headache [42,46], dry mouth [45], sleepiness [46], feelings of unreality [45], dissociation [46,49,55,56,62], dizziness [13], hallucinations [40,42,43], gaps in memory [55,56], sensory distortions [55,56], anxiety [43] and increases in systolic blood pressure [55,56,58]. Interestingly, unexpected suicidal thinking was observed, together with delayed-onset dysphoria and anxiety, in some patients diagnosed with OCD, but these patients were not recorded as being depressed [55,56].…”

Section: Resultsmentioning

confidence: 99%

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Therapeutic Potentials of Ketamine and Esketamine in Obsessive–Compulsive Disorder (OCD), Substance Use Disorders (SUD) and Eating Disorders (ED): A Review of the Current Literature

et al. 2021

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The obsessive–compulsive spectrum refers to disorders drawn from several diagnostic categories that share core features related to obsessive–compulsive disorder (OCD), such as obsessive thoughts, compulsive behaviors and anxiety. Disorders that include these features can be grouped according to the focus of the symptoms, e.g., bodily preoccupation (i.e., eating disorders, ED) or impulse control (i.e., substance use disorders, SUD), and they exhibit intriguing similarities in phenomenology, etiology, pathophysiology, patient characteristics and clinical outcomes. The non-competitive N-methyl-D-aspartate receptor (NMDAr) antagonist ketamine has been indicated to produce remarkable results in patients with treatment-resistant depression, post-traumatic stress disorder and OCD in dozens of small studies accrued over the past decade, and it appears to be promising in the treatment of SUD and ED. However, despite many small studies, solid evidence for the benefits of its use in the treatment of OCD spectrum and addiction is still lacking. Thus, the aim of this perspective article is to examine the potential for ketamine and esketamine in treating OCD, ED and SUD, which all involve recurring and intrusive thoughts and generate associated compulsive behavior. A comprehensive and updated overview of the literature regarding the pharmacological mechanisms of action of both ketamine and esketamine, as well as their therapeutic advantages over current treatments, are provided in this paper. An electronic search was performed, including all papers published up to April 2021, using the following keywords (“ketamine” or “esketamine”) AND (“obsessive” OR “compulsive” OR “OCD” OR “SUD” OR “substance use disorder” OR “addiction” OR “craving” OR “eating” OR “anorexia”) NOT review NOT animal NOT “in vitro”, on the PubMed, Cochrane Library and Web of Science online databases. The review was conducted in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The use and efficacy of ketamine in SUD, ED and OCD is supported by glutamatergic neurotransmission dysregulation, which plays an important role in these conditions. Ketamine’s use is increasing, and preliminary data are optimistic. Further studies are needed in order to better clarify the many unknowns related to the use of both ketamine and esketamine in SUD, ED and OCD, and to understand their long-term effectiveness.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Therapeutic Potentials of Ketamine and Esketamine in Obsessive–Compulsive Disorder (OCD), Substance Use Disorders (SUD) and Eating Disorders (ED): A Review of the Current Literature

et al. 2021

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Three daily intraperitoneal injections of sub‐anesthetic ketamine ameliorate activity‐based anorexia vulnerability of adult female mice

Goodwin‐Groen,

Dong,

Aoki

2023

Intl J Eating Disorders

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ObjectiveTo identify ketamine's dosing schedule that ameliorates voluntary food restriction, hyperactivity and body weight loss of adult mice undergoing activity‐based anorexia (ABA), an animal model of anorexia nervosa.MethodFemale and male C57BL6 mice underwent three cycles of ABA, starting from mid‐adolescence. ABA vulnerability was compared within and across two groups of animals: those injected intraperitoneally with 30 mg/kg ketamine for three consecutive days (30mgKetx3) during the second ABA in late adolescence (ABA2) or with vehicle only (Vx3).ResultsVx3 females and males exhibited individual differences in wheel running and weight retention during first ABA in mid‐adolescence (ABA1), ABA2, and third ABA in adulthood (ABA3). Their wheel running correlated with anxiety‐like behavior. During ABA1 and ABA3, weight gain of Vx3 females (but not males) after food consumption correlated negatively with food‐anticipatory activity (FAA) preceding the feeding hours, indicating that females with higher levels of running restrict feeding more and persistently. This paradoxical relationship confirms earlier findings of ABA females without ketamine treatment, capturing the maladaptive behaviors exhibited by individuals diagnosed with anorexia nervosa. By contrast, 30mgKetx3 had an effect on both sexes of reducing hyperactivity during the feeding hours acutely and reducing anxiety‐like behavior's contribution to running. For females, only, 30mgKetx3 acutely improved the extent of compensatory food consumption relative to FAA and improved weight retention during ABA3, 12 days post ketamine in adulthood.DiscussionSub‐anesthetic ketamine evokes behavior‐specific ameliorative effects for adult mice re‐experiencing ABA, supporting the notion that multiple doses of ketamine may be helpful in reducing relapse among adults with anorexia nervosa.Public Significance StatementThis study examined whether ketamine reduces anorexia‐like behaviors in adult mice. Three daily sub‐anesthetic ketamine injections suppress wheel running during and leading up to the hours of food availability and enable animals to compensate better for weight loss associated with excessive exercise by eating more. These findings suggest that ketamine may help adult females diagnosed with anorexia nervosa but also point to sex‐ and age‐related differences in the action of ketamine.

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Novel treatments for anorexia nervosa: Insights from neuroplasticity research

Keeler,

Kan,

Treasure

et al. 2023

Euro Eating Disorders Rev

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ObjectiveTreatment for anorexia nervosa (AN) remains challenging; there are no approved psychopharmacological interventions and psychotherapeutic strategies have variable efficacy. The investigation of evidence‐based treatments has so far been compounded by an underdeveloped understanding into the neurobiological changes associated with the acute stages of AN. There is converging evidence of deficiencies in neuroplasticity in AN.MethodThis paper provides an overview of neuroimaging, neuropsychological, molecular and qualitative findings relating to neuroplasticity in AN, translating these findings to the identification of novel biological and psychotherapeutic strategies.ResultsNovel psychopharmacological approaches that may ameliorate deficiencies in neuroplasticity include medications such as ketamine, psilocybin and human recombinant leptin. Anti‐inflammatory medications and brain‐derived neurotrophic factor mimetics may emerge as potential treatments following further research. Psychotherapeutic strategies that may target neuroplastic deficiencies, as well as having wider effects on identity, include imagery rescripting, memory specificity training, cognitive remediation therapy, exposure therapies, narrative therapies, cultural interventions (e.g. music and arts therapies) and yoga/mindfulness‐based interventions.ConclusionsTreatments specifically targeted towards mitigating the neurobiological sequalae of AN are warranted, and emerging neurobiological and neuropsychological research utilising longitudinal designs and large sample sizes, as well as initial feasibility studies, are necessitated to bolster translational efforts.

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A longitudinal case series of IM ketamine for patients with severe and enduring eating disorders and comorbid treatment‐resistant depression

Cited by 31 publications

References 13 publications

Therapeutic Potentials of Ketamine and Esketamine in Obsessive–Compulsive Disorder (OCD), Substance Use Disorders (SUD) and Eating Disorders (ED): A Review of the Current Literature

Therapeutic Potentials of Ketamine and Esketamine in Obsessive–Compulsive Disorder (OCD), Substance Use Disorders (SUD) and Eating Disorders (ED): A Review of the Current Literature

Three daily intraperitoneal injections of sub‐anesthetic ketamine ameliorate activity‐based anorexia vulnerability of adult female mice

Novel treatments for anorexia nervosa: Insights from neuroplasticity research

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