Keeler Johanna Louise, Treasure Janet, Himmerich Hubertus, Brendle Madeline, Moore Claire, Robison Reid
Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, United Kingdom.
Front Psychiatry. 2023 May 15;14:1181447. doi: 10.3389/fpsyt.2023.1181447. eCollection 2023.
A comorbid diagnosis of a depressive disorder is a negative prognostic factor for individuals with AN, and novel treatments are needed to target depressive symptoms in this population. One emerging promising treatment for depressive disorders is ketamine, although there is less research investigating the use of ketamine for alleviating depression in people with AN.
This study reports on four patients with a lifetime diagnosis of AN and a comorbid diagnosis of major depressive disorder who received either intramuscular ketamine ( = 2) or intranasal esketamine ( = 2) treatment from a private psychiatric clinic. Depressive symptomatology (PHQ-9) was measured prior to (es)ketamine administration on every dosing session and adverse effects were recorded during and after dosing. All patients reported a subjective decrease in depression, although only those administered intranasal esketamine showed a reduction in PHQ-9 depression scores over time. Number of doses ranged from 3 to 23. All patients tolerated treatment well and no serious adverse effects emerged, however nausea/vomiting was experienced by one patient on one dosing session. Weight remained stable in all cases, although notably across all patients, weight at the beginning of treatment was within a "healthy" range.
These findings suggest that (es)ketamine may reduce depressive symptoms in people with major depressive disorder and a comorbid diagnosis of AN. Future feasibility and pilot trials are warranted in order to elicit robust data on efficacy, acceptability, safety and tolerability.
抑郁症的共病诊断是神经性厌食症患者的一个负面预后因素，因此需要新的治疗方法来针对该人群的抑郁症状。氯胺酮是一种新兴的、有前景的抑郁症治疗方法，尽管针对氯胺酮用于缓解神经性厌食症患者抑郁症状的研究较少。
本研究报告了4例终生诊断为神经性厌食症且合并重度抑郁症的患者，他们在一家私立精神科诊所接受了肌肉注射氯胺酮（n = 2）或鼻内艾司氯胺酮（n = 2）治疗。在每次给药前测量抑郁症状（PHQ-9），并在给药期间和给药后记录不良反应。所有患者均报告主观上抑郁有所减轻，尽管只有接受鼻内艾司氯胺酮治疗的患者随着时间推移PHQ-9抑郁评分有所降低。给药次数从3次到23次不等。所有患者对治疗耐受性良好，未出现严重不良反应，不过有1例患者在一次给药时出现恶心/呕吐。所有病例体重均保持稳定，不过值得注意的是，所有患者在治疗开始时的体重都在“健康”范围内。
这些发现表明，（艾司）氯胺酮可能会减轻重度抑郁症合并神经性厌食症患者的抑郁症状。未来有必要进行可行性和试点试验，以获取关于疗效、可接受性、安全性和耐受性的有力数据。
