Ketamine in a Patient with Comorbid Anorexia and MDD

Dechant, Esther; Boyle, Brian; Ross, Rachel

doi:10.26502/fjwhd.2644-28840044

Cited by 16 publications

(14 citation statements)

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“…Ketamine assisted psychotherapy (KAP) has therefore been utilized to prolong ketamine's efficacy and maximize therapeutic outcomes (29)(30)(31)(32)(33)(34). To date, few studies have used ketamine for the treatment of eating disorders, including one open-label study (35), two case reports (36,37), and one longitudinal case series (38), all of which administered ketamine without a psychotherapeutic component. Nonetheless, the results are encouraging.…”

Section: Introductionmentioning

confidence: 99%

Case Report: Unexpected Remission From Extreme and Enduring Bulimia Nervosa With Repeated Ketamine Assisted Psychotherapy

et al. 2021

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Background: Bulimia nervosa is a disabling psychiatric disorder that considerably impairs physical health, disrupts psychosocial functioning, and reduces overall quality of life. Despite available treatment, less than half of sufferers achieve recovery and approximately a third become chronically ill. Extreme and enduring cases are particularly resistant to first-line treatment, namely antidepressants and cognitive behavioral therapy, and have the highest rate of premature mortality. Here, we demonstrate that in such cases, repeated sessions of ketamine assisted psychotherapy (KAP) is an effective treatment alternative for improving symptoms.Case Presentation: A 21-year-old woman presented with extreme and enduring bulimia nervosa. She reported recurrent binge-eating and purging by self-induced vomiting 40 episodes per day, which proved refractory to both pharmacological and behavioral treatment at the outpatient, residential, and inpatient level. Provided this, her physician recommended repeated KAP as an exploratory and off-label intervention for her eating disorder. The patient underwent three courses of KAP over 3 months, with each course consisting of six sessions scheduled twice weekly. She showed dramatic reductions in binge-eating and purging following the first course of treatment that continued with the second and third. Complete cessation of behavioral symptoms was achieved 3 months post-treatment. Her remission has sustained for over 1 year to date.Conclusions: To our knowledge, this is the first report of repeated KAP used to treat bulimia nervosa that led to complete and sustained remission, a rare outcome for severe and enduring cases, let alone extreme ones. Additionally, it highlights the degree to which KAP can be tailored at the individual level based on symptom severity and treatment response. While its mechanism of action is unclear, repeated KAP is a promising intervention for bulimia nervosa that warrants future research and clinical practice consideration.

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Section: Introductionmentioning

confidence: 99%

Case Report: Unexpected Remission From Extreme and Enduring Bulimia Nervosa With Repeated Ketamine Assisted Psychotherapy

et al. 2021

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“…Another case of severe and enduring AN complicated by major depression showed initial, but not sustained, response to ketamine treatment [120]. The 29-year-old female presented with chronic refractory AN-R and comorbid MDD of 11+ years, with persistent borderline and narcissistic personality features, as well active suicidality.…”

Section: Use Of Ketamine In Eating Disordersmentioning

confidence: 97%

“…To date, few studies have examined the therapeutic use of ketamine for EDs, which are limited to case series [117,118] and reports [119][120][121] (Table 1); and are focused on AN over other primary (BN and BED) and secondary (pica, RD, and ARFID) subgroups. Mills et al first introduced the dissociative anesthetic as a novel treatment for compulsive EDs in 1998, where 15 patients with atypical, chronic refractory AN of 11.3 years ± 5.0 were treated with intermittent ketamine infusions combined with oral nalmefene, an opiate receptor antagonist [117].…”

Section: Use Of Ketamine In Eating Disordersmentioning

confidence: 99%

“…Interest in transdiagnostic applications has since grown, with more than 140 clinical trials in the National Institute of Health database (ClinicalTrials.gov) registered to investigate ketamine's therapeutic potential, comprising major depression (98; 70%), suicidal ideation (21; 15%), post-traumatic stress disorder (7; 5%), obsessive compulsive disorder (5; 3.6%), autism spectrum disorder (2; 1.4%), generalized anxiety disorder (1; 0.7%), borderline personality disorder (1; 0.7%), cognitive impairment (1; 0.7%) and schizophrenia (1; 0.7%) [111]. While data concerning ketamine and EDs is preliminary and principally limited to AN [117][118][119][120][121], results are nonetheless encouraging. A recent mixedmethods study (N = 200), examining patient attitudes towards complementary and emerging treatments for EDs, also provides evidence of support for psychedelics, including ketamine.…”

Section: Future Perspectives and Directionsmentioning

confidence: 99%

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Ketamine as a Novel Psychopharmacotherapy for Eating Disorders: Evidence and Future Directions

Ragnhildstveit¹,

Slayton²,

Jackson³

et al. 2022

Preprint

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Eating disorders (EDs) are serious, life-threatening psychiatric conditions associated with physical and psychosocial impairments, as well as high morbidity and mortality. Given the chronic refractory nature of EDs and the paucity of evidence-based treatments, there is a pressing need to identify novel approaches for this population. The noncompetitive N-methyl-D-aspartate receptor (NMDAr) antagonist, ketamine, has recently been approved for treatment-resistant depression, which exhibits rapid and robust antidepressant effects, particularly among clinical non-responders. It is now being investigated for several new indications, including obsessive-compulsive, post-traumatic, and substance use disorder; and shows transdiagnostic potential for EDs. As such, the aim of this review is to examine contemporary findings on the treatment of EDs with ketamine, whether used as a primary, adjunctive, or combination pharmacotherapy. Avenues for future research are also discussed. Overall, results are encouraging and point to therapeutic value, yet are limited to case series and reports principally on anorexia nervosa. Further empirical work is thus needed to explore and establish ketamine efficacy for EDs, and to inform targeted treatment strategies.

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“…To date, there have been few studies investigating the therapeutic use of ketamine for AN, most of which have been case series or reports. Table 2 provides an overview of the study characteristics and main findings; all studies found reductions in the main outcome measures, including depression scores, suicidality and eating disorder psychopathology [171][172][173][174]. To date, all investigations of ketamine as a treatment for AN have been in adult patients.…”

Section: Current Researchmentioning

confidence: 99%

Ketamine as a Treatment for Anorexia Nervosa: A Narrative Review

et al. 2021

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Anorexia nervosa (AN) is a highly complex disorder to treat, especially in severe and enduring cases. Whilst the precise aetiology of the disorder is uncertain, malnutrition and weight loss can contribute to reductions in grey and white matter of the brain, impairments in neuroplasticity and neurogenesis and difficulties with cognitive flexibility, memory and learning. Depression is highly comorbid in AN and may be a barrier to recovery. However, traditional antidepressants are often ineffective in alleviating depressive symptoms in underweight patients with AN. There is an urgent need for new treatment approaches for AN. This review gives a conceptual overview for the treatment of AN with ketamine. Ketamine has rapid antidepressant effects, which are hypothesised to occur via increases in glutamate, with sequelae including increased neuroplasticity, neurogenesis and synaptogenesis. This article provides an overview of the use of ketamine for common psychiatric comorbidities of AN and discusses particular safety concerns and side effects. Potential avenues for future research and specific methodological considerations are explored. Overall, there appears to be ample theoretical background, via several potential mechanisms, that warrant the exploration of ketamine as a treatment for adults with AN.

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Ketamine in a Patient with Comorbid Anorexia and MDD

Cited by 16 publications

References 0 publications

Case Report: Unexpected Remission From Extreme and Enduring Bulimia Nervosa With Repeated Ketamine Assisted Psychotherapy

Case Report: Unexpected Remission From Extreme and Enduring Bulimia Nervosa With Repeated Ketamine Assisted Psychotherapy

Ketamine as a Novel Psychopharmacotherapy for Eating Disorders: Evidence and Future Directions

Ketamine as a Treatment for Anorexia Nervosa: A Narrative Review

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