Case Report: Unexpected Remission From Extreme and Enduring Bulimia Nervosa With Repeated Ketamine Assisted Psychotherapy.
Anya Ragnhildstveit, Laura Kate Jackson, Sarah Cunningham, Linda Good, Quinn Tanner, Matthew Roughan, Patricia Henrie-Barrus
Frontiers in Psychiatry 2021 DOI: 10.3389/fpsyt.2021.764112 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | 21-year-old woman with extreme and enduring bulimia nervosa |
| Intervention | Ketamine assisted psychotherapy |
| Duration | 3-month intervention, 3-month follow-up to symptom cessation, over 1 year total remission |
| Topics | Ketamine Esketamine Psychedelic-assisted therapy |
| Keywords | Binge-eating Bulimia nervosa Case report Eating disorder Ketamine assisted psychotherapy Psychopharmacology Purging |
| Key findings | Repeated KAP led to complete and sustained remission of binge-eating and purging in a patient with extreme and enduring bulimia nervosa. |
Abstract
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.