Case Report: Unexpected Remission From Extreme and Enduring Bulimia Nervosa With Repeated Ketamine Assisted Psychotherapy

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 il...

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Autores principales:	Anya Ragnhildstveit, Laura Kate Jackson, Sarah Cunningham, Linda Good, Quinn Tanner, Matthew Roughan, Patricia Henrie-Barrus
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	bulimia nervosa eating disorder binge-eating purging ketamine ketamine assisted psychotherapy Psychiatry RC435-571
Acceso en línea:	https://doaj.org/article/76bbb24cd02b4fcca698a6665a374262
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spelling	oai:doaj.org-article:76bbb24cd02b4fcca698a6665a3742622021-11-17T04:59:21ZCase Report: Unexpected Remission From Extreme and Enduring Bulimia Nervosa With Repeated Ketamine Assisted Psychotherapy1664-064010.3389/fpsyt.2021.764112https://doaj.org/article/76bbb24cd02b4fcca698a6665a3742622021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fpsyt.2021.764112/fullhttps://doaj.org/toc/1664-0640Background: 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.Anya RagnhildstveitLaura Kate JacksonSarah CunninghamLinda GoodQuinn TannerMatthew RoughanMatthew RoughanPatricia Henrie-BarrusPatricia Henrie-BarrusFrontiers Media S.A.articlebulimia nervosaeating disorderbinge-eatingpurgingketamineketamine assisted psychotherapyPsychiatryRC435-571ENFrontiers in Psychiatry, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	bulimia nervosa eating disorder binge-eating purging ketamine ketamine assisted psychotherapy Psychiatry RC435-571
spellingShingle	bulimia nervosa eating disorder binge-eating purging ketamine ketamine assisted psychotherapy Psychiatry RC435-571 Anya Ragnhildstveit Laura Kate Jackson Sarah Cunningham Linda Good Quinn Tanner Matthew Roughan Matthew Roughan Patricia Henrie-Barrus Patricia Henrie-Barrus Case Report: Unexpected Remission From Extreme and Enduring Bulimia Nervosa With Repeated Ketamine Assisted Psychotherapy
description	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.
format	article
author	Anya Ragnhildstveit Laura Kate Jackson Sarah Cunningham Linda Good Quinn Tanner Matthew Roughan Matthew Roughan Patricia Henrie-Barrus Patricia Henrie-Barrus
author_facet	Anya Ragnhildstveit Laura Kate Jackson Sarah Cunningham Linda Good Quinn Tanner Matthew Roughan Matthew Roughan Patricia Henrie-Barrus Patricia Henrie-Barrus
author_sort	Anya Ragnhildstveit
title	Case Report: Unexpected Remission From Extreme and Enduring Bulimia Nervosa With Repeated Ketamine Assisted Psychotherapy
title_short	Case Report: Unexpected Remission From Extreme and Enduring Bulimia Nervosa With Repeated Ketamine Assisted Psychotherapy
title_full	Case Report: Unexpected Remission From Extreme and Enduring Bulimia Nervosa With Repeated Ketamine Assisted Psychotherapy
title_fullStr	Case Report: Unexpected Remission From Extreme and Enduring Bulimia Nervosa With Repeated Ketamine Assisted Psychotherapy
title_full_unstemmed	Case Report: Unexpected Remission From Extreme and Enduring Bulimia Nervosa With Repeated Ketamine Assisted Psychotherapy
title_sort	case report: unexpected remission from extreme and enduring bulimia nervosa with repeated ketamine assisted psychotherapy
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/76bbb24cd02b4fcca698a6665a374262
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Case Report: Unexpected Remission From Extreme and Enduring Bulimia Nervosa With Repeated Ketamine Assisted Psychotherapy

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