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Treatment of compulsive behaviour in eating disorders with intermittent ketamine infusions

Ian G. Mills

The Quarterly journal of medicine July 1, 1998 DOI: 10.1093/qjmed/91.7.493 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Case series Case report Peer reviewed
Sample size 15
Population Chronic and treatment-resistant eating disorder patients
Interventions Ketamine Nalmefene
Dose 20 mg per hour ketamine for 10 h; nalmefene 20 mg twice daily
Duration Two to nine ketamine infusions at intervals of 5 days to 3 weeks
Measures Compulsion score
Topics Esketamine Ketamine
Citations 92
Key findings Nine of 15 patients showed prolonged remission after ketamine infusions, with a significant drop in mean Compulsion score from 44.0 to 27.0. Six patients showed no significant response, possibly because compulsive drive re-established too soon or nalmefene dose was too low.

Abstract

We have previously shown that eating disorders are a compulsive behaviour disease, characterized by frequent recall of anorexic thoughts. Evidence suggests that memory is a neocortical neuronal network, excitation of which involves the hippocampus, with recall occurring by re-excitement of the same specific network. Excitement of the hippocampus by glutamate-NMDA receptors, leading to long-term potentiation (LTP), can be blocked by ketamine. Continuous block of LTP prevents new memory formation but does not affect previous memories. Opioid antagonists prevent loss of consciousness with ketamine but do not prevent the block of LTP. We used infusions of 20 mg per hour ketamine for 10 h with 20 mg twice daily nalmefene as opioid antagonist to treat 15 patients with a long history of eating disorder, all of whom were chronic and resistant to several other forms of treatment. Nine (responders) showed prolonged remission when treated with two to nine ketamine infusions at intervals of 5 days to 3 weeks. Clinical response was associated with a significant decrease in Compulsion score: before ketamine, mean +/- SE was 44.0 +/- 2.5; after ketamine, 27.0 +/- 3.5 (t test, p = 0.0016). In six patients (non-responders) the score was: before ketamine, 42.8 +/- 3.7; after ketamine, 44.8 +/- 3.1. There was no significant response to at least five ketamine treatments, perhaps because the compulsive drive was re-established too soon after the infusion, or because the dose of opioid antagonist, nalmefene, was too low.

Comparable studies

Other case reports and case series on ketamine, most cited first.

Study Year Design Participants
The destruction of the lower urinary tract by ketamine abuse: a new syndrome? Young recreational abusers of street-ketamine in Hong Kong referred to urology units 2008 Retrospective case series n = 59
Electroconvulsive Therapy, Ketamine, and Esketamine in a Patient with Major Depressive Disorder and Multiple Comorbidities: A Case Report over 10-year Treatment from Adolescence to Adulthood. A patient with treatment-resistant depression and comorbid generalized anxiety... 2025 Case report n = 1
Oral Administration of the NMDA Receptor Antagonist S-Ketamine as Add-On Therapy of Depression: A Case Series Four depressed patients taking standard antidepressants 2009 Case series n = 4
A longitudinal case series of IM ketamine for patients with severe and enduring eating disorders and comorbid treatment‐resistant depression Patients with enduring eating disorders and treatment-resistant depression 2021 Case series n = 4
Ketamine-Enhanced Psychotherapy: Preliminary Clinical Observations on its Effects in Treating Death Anxiety Terminally-ill people suffering death anxiety 2007 Review and case study n = 2

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