Intranasal ketamine was linked to improvement in eating-disorder patients with resistant mood disorders, but no more than matched patients who did not receive ketamine.
Evidence
This matched comparison study included 85 adults receiving ketamine and 85 matched controls in higher-level eating-disorder care, measuring EDE-Q, PHQ-9, suicidal ideation, and GAD-7 from admission to discharge.
Caveat
Both groups improved similarly on all measured outcomes, and the ketamine group had longer lengths of stay, limiting inference about ketamine-specific benefit.
Simplified
BACKGROUND: Individuals with (EDs) have an increased risk of (TRD) and treatment resistant bipolar disorder (TRBD) and a higher rate of suicidal ideation and death by suicide than individuals without EDs. Individuals with EDs are less responsive to conventional treatments for mood disorders than individuals without EDs. Ketamine has evidence for treatment of TRD and TRBD and for the treatment of acute suicidality. Ketamine has also been shown to be safe in individuals with EDs who are malnourished. This study is among the first to examine the efficacy of ketamine in TRD and TRBD in patients with co-occurring EDs at higher levels of care.
METHODS: Participants were 85 adults admitted to an ED treatment facility who received subanesthetic intranasal generic ketamine compared to a sample of 85 adults matched for age, sex, gender, race, diagnosis, and level of care at admission admitted to the same facilities who did not receive ketamine. Participants completed the Eating Disorder Examination Questionnaire (EDE-Q), Patient Health Questionnaire-9 (PHQ-9), suicidal ideation (PHQ-9 Item 9) and Generalized Anxiety Disorder-7 (GAD-7) at admission and discharge.
RESULTS: Patients receiving ketamine and matched controls were not significantly different on age, sex, gender, race, diagnosis, or level of care at admission. There were no significant differences between groups on admission for all EDE-Q subscales, PHQ-9, suicidal ideation, or GAD. All patients, irrespective of use of ketamine, improved significantly from admission to discharge on all outcomes. There were no significant differences between groups for change in all EDE-Q subscales, change in PHQ-9, change in suicidal ideation, or change in GAD-7. Patients receiving ketamine had significantly longer lengths of stay than controls (b = 0.39, p = .01). The lack of significant differences was maintained irrespective of predicting raw change, controlling for admission scores, or additionally controlling for length of stay.
CONCLUSIONS: In a population of individuals seeking higher level of care for an ED and controls matched for age, gender, sex, diagnosis, level of care, and race, treatment with ketamine was associated with significant reductions in depression and ED severity, but not more so than individuals not treated with ketamine. Findings from the study suggest that ketamine may be a viable treatment option for individuals with EDs, however, further research is needed to determine ketamine's efficacy in treating EDs with comorbid depression.
Key numbers
113 days
Longer Length of Stay
Average length of stay for patients receiving ketamine
170
Improvement in Symptoms
Total number of participants in the study
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