Timek Amanda, Daniels-Brady Catherine, Ferrando Stephen
Westchester Medical Center, 100 Woods Road, 10595, Valhalla, NY, USA.
J Eat Disord. 2024 Jun 12;12(1):79. doi: 10.1186/s40337-024-01039-3.
Anorexia nervosa is a life-threatening psychiatric illness with a high mortality rate and limited treatment options. This illness is frequently comorbid with major depressive disorder, leading to additional obstacles in patient quality of life, and increasing the mortality rate further due to risk of suicide. Ketamine, a competitive N-methyl-D-aspartate receptor antagonist, has been shown to be beneficial in depression given its effects on neuroplasticity. There are few cases in the literature describing ketamine use in patients with eating disorders, and even fewer that describe psychotherapy-assisted ketamine use in this patient population. We present the case of a 33-year-old woman with a history of severe and enduring anorexia nervosa and comorbid major depressive disorder who we treated safely with ketamine-assisted psychotherapy using intravenous ketamine in a general hospital setting.
Our patient is a 33-year-old woman with past psychiatric history of severe and enduring anorexia nervosa and major depressive disorder with comorbid psychiatric and medical conditions who presented to the hospital due to malnutrition. She had an extensive psychiatric history as well as multiple medical hospitalizations due to her eating disorder. She had tried numerous psychiatric treatments, including antidepressants, mood stabilizers, antipsychotics, electroconvulsive therapy, and multiple types of therapies without significant improvement in symptoms. She agreed to try ketamine for treatment-resistant depression and received it intravenously for seven sessions in a closely monitored setting, and simultaneously engaged in acceptance and commitment therapy during sessions. She demonstrated increased cognitive flexibility, disappearance of suicidal ideation, and reduction in Beck Depression Inventory Scores.
Our case is unique in that it demonstrates the successful usage of ketamine-assisted psychotherapy in a hospital setting with severe and enduring anorexia nervosa and comorbid major depressive disorder. Her body mass index was profoundly low at 13, whereas the lowest documented in the literature was 16.9. This case shows that ketamine-assisted psychotherapy may be a promising treatment modality for patients with anorexia nervosa with co-morbid depression who have failed other interventions.
神经性厌食症是一种危及生命的精神疾病，死亡率高且治疗选择有限。这种疾病常与重度抑郁症共病，给患者的生活质量带来额外障碍，并因自杀风险进一步提高死亡率。氯胺酮是一种竞争性N-甲基-D-天冬氨酸受体拮抗剂，鉴于其对神经可塑性的作用，已被证明对抑郁症有益。文献中描述氯胺酮用于饮食失调患者的案例很少，描述心理治疗辅助氯胺酮用于该患者群体的案例更少。我们报告一例33岁女性患者，她有严重且持久的神经性厌食症病史，并伴有重度抑郁症，我们在综合医院环境中使用静脉注射氯胺酮进行氯胺酮辅助心理治疗，安全地对其进行了治疗。
我们的患者是一名33岁女性，既往有严重且持久的神经性厌食症和重度抑郁症病史，伴有多种精神和躯体疾病，因营养不良入院。由于饮食失调，她有广泛的精神病史以及多次住院治疗经历。她尝试过多种精神治疗方法，包括抗抑郁药、心境稳定剂、抗精神病药、电休克治疗以及多种类型的心理治疗，但症状均无明显改善。她同意尝试氯胺酮治疗难治性抑郁症，并在密切监测的环境中接受了7次静脉注射氯胺酮治疗，同时在治疗期间接受接纳与承诺疗法。她表现出认知灵活性增强、自杀观念消失以及贝克抑郁量表评分降低。
我们的病例具有独特性，因为它展示了在患有严重且持久的神经性厌食症并伴有重度抑郁症的患者中，氯胺酮辅助心理治疗在医院环境中的成功应用。她的体重指数极低，仅为13，而文献记载的最低值为16.9。该病例表明，氯胺酮辅助心理治疗可能是一种有前景的治疗方式，适用于其他干预措施无效的伴有抑郁症的神经性厌食症患者。
