Dahlgren Camilla Lindvall, Tverrli Elisabeth, Stewart Lowan Han
Department of Psychology, Oslo New University College, Oslo, Norway.
Axon Clinics, Oslo, Norway.
J Eat Disord. 2025 Jun 10;13(1):107. doi: 10.1186/s40337-025-01313-y.
Ketamine, an N-methyl-D-aspartate receptor antagonist, has demonstrated rapid antidepressant effects at sub-anesthetic doses, making it a promising candidate for treatment-resistant mood disorders, anxiety, post-traumatic stress disorder, suicidality, and recently, eating disorders (EDs). However, its effects are transient, and ketamine-assisted psychotherapy (KAP) has emerged as a method to extend therapeutic benefits by combining ketamine's heightened neuroplasticity with psychotherapy. Emerging evidence suggests KAP can reduce ED psychopathology and alleviate comorbid symptoms of depression and anxiety, potentially improving patients' engagement in psychotherapy and enhancing treatment outcomes.
This study presents a 5-month follow-up of a female patient in her late twenties who underwent a structured treatment protocol consisting of four KAP sessions delivered within an Acceptance and Commitment (ACT) framework, plus three ketamine booster treatments. At intake, the patient presented with a diagnosis of anorexia nervosa (AN) and comorbid depression, reporting persistent intrusive thoughts about food and body image, dissatisfaction with prior treatments, and only partial relief from antidepressants. The patient sought ketamine treatment to improve energy levels, emotional flexibility, and overall quality of life. Assessments, including medical evaluations and self-reported measures of eating disorder pathology, depression, anxiety, suicidal ideation, quality of life, psychological flexibility, and ketamine-related side effects, were conducted at five time points both before and after the intervention. The primary aim was to investigate potential changes in ED psychopathology and comorbid symptoms follwoing treatment.
To our knowledge, this is the first documented case of structured KAP for AN showing both rapid and sustained symptom remission five months post-treatment, as well as the first European study to comprehensively investigate outcomes associated with KAP in EDs. Changes observed across most assessments indicated a consistent pattern: marked symptom reduction from baseline through the fourth KAP session, followed by a temporary symptom increase during the therapy-free interval between the final KAP session and the first ketamine booster dose. Symptoms then declined during the booster phase, with stabilization or further improvement at five-month follow-up. Ketamine was well-tolerated, with no increase in side effects or emergence of new symptoms. While preliminary findings are promising, important knowledge gaps remain. These include ketamine's applicability across ED subtypes, severity levels, and age groups, as well as optimal treatment and assessment protocols that support long-term therapeutic effects and prevent relapse.
氯胺酮是一种N-甲基-D-天冬氨酸受体拮抗剂，已证明在亚麻醉剂量下具有快速抗抑郁作用，使其成为治疗抵抗性情绪障碍、焦虑症、创伤后应激障碍、自杀倾向以及最近出现的饮食失调（ED）的有前景的候选药物。然而，其效果是短暂的，氯胺酮辅助心理治疗（KAP）已成为一种通过将氯胺酮增强的神经可塑性与心理治疗相结合来延长治疗益处的方法。新出现的证据表明，KAP可以减轻饮食失调的精神病理学症状，缓解抑郁和焦虑的共病症状，可能提高患者参与心理治疗的程度并改善治疗效果。
本研究对一名快30岁的女性患者进行了为期5个月的随访，该患者接受了一个结构化治疗方案，包括在接受与承诺疗法（ACT）框架内进行的四次KAP治疗，外加三次氯胺酮强化治疗。在初次就诊时，该患者被诊断为神经性厌食症（AN）并伴有共病抑郁症，报告称持续存在关于食物和身体形象的侵入性想法，对先前的治疗不满意，并且服用抗抑郁药后仅部分缓解。患者寻求氯胺酮治疗以提高能量水平、情绪灵活性和整体生活质量。在干预前后的五个时间点进行了评估，包括医学评估以及饮食失调病理学、抑郁症、焦虑症、自杀意念、生活质量、心理灵活性和氯胺酮相关副作用的自我报告测量。主要目的是调查治疗后饮食失调精神病理学和共病症状的潜在变化。
据我们所知，这是第一例有记录的针对AN的结构化KAP病例，显示治疗后5个月症状快速且持续缓解，也是第一项全面调查KAP在饮食失调中相关结果的欧洲研究。在大多数评估中观察到的变化表明了一种一致的模式：从基线到第四次KAP治疗期间症状明显减轻，然后在最后一次KAP治疗与第一次氯胺酮强化剂量之间的无治疗间隔期症状暂时增加。然后在强化阶段症状下降，在5个月随访时稳定或进一步改善。氯胺酮耐受性良好，副作用没有增加，也没有出现新的症状。虽然初步结果很有希望，但仍存在重要的知识空白。这些包括氯胺酮在不同饮食失调亚型、严重程度水平和年龄组中的适用性，以及支持长期治疗效果和预防复发的最佳治疗和评估方案。
