Lori Calabrese1, Barbara Scolnick2, Beth Zupec-Kania3, Caroline Beckwith4, Kayla Costello5, Guido K W Frank6. 1. Innovative Psychiatry, South Windsor, CT, USA. drcalabrese@innovativepsychiatry.com. 2. Internal Medicine and Addiction Medicine, Waban, MA, USA. 3. Ketogenic Diet Therapy, Elm Grove, WI, USA. 4. Clinical Peer Counselor, New York, NY, USA. 5. Center of Excellence in Eating and Weight Disorders, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 6. Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
Abstract
PURPOSE: Anorexia nervosa (AN) is a severe psychiatric disorder, and shape and weight concerns are often chronic despite weight normalization. No specific treatments exist for those preoccupations that interfere with recovery and trigger relapse. A case study using a ketogenic diet followed by ketamine infusions led to sustained remission in one patient with chronic AN. Here we conducted an open-label trial to test whether this response could be replicated. METHODS: Five adults weight recovered from AN but with persistent eating disorder thoughts and behaviors adopted a therapeutic ketogenic diet (TKD) aimed at maintaining weight. After sustaining nutritional ketosis, participants received six ketamine infusions and were followed over 6 months. RESULTS: All participants completed the study protocol without significant adverse effects. Two participants maintained TKD for 8 weeks prior to ketamine infusions due to good behavioral response and remained on TKD. Three participants received TKD for 4 weeks prior to and during ketamine, then tapered off after the final infusion. The group showed significant improvements on the Clinical Impairment Assessment (p = 0.008), Eating Disorder Examination Questionnaire (EDEQ) Global score (p = 0.006), EDEQ-Eating Concerns (p = 0.005), EDEQ-Shape Concerns (p = 0.016), EDEQ-Weight Concerns (p = 0.032), Eating Disorders Recovery Questionnaire (EDRQ) Acceptance of Self and Body (0.027) and EDRQ-Social and Emotional Connection (p = 0.001). Weight remained stable, except for one participant who relapsed 4 months after treatment and off TKD. CONCLUSION: This novel treatment appears to be safe and effective for adults with chronic AN-related psychopathology. The results from this open trial support that there are specific neurobiological underpinnings of AN that can be normalized using TKD and ketamine. LEVEL OF EVIDENCE: Level IV, multiple time series with intervention.
PURPOSE: Anorexia nervosa (AN) is a severe psychiatric disorder, and shape and weight concerns are often chronic despite weight normalization. No specific treatments exist for those preoccupations that interfere with recovery and trigger relapse. A case study using a ketogenic diet followed by ketamine infusions led to sustained remission in one patient with chronic AN. Here we conducted an open-label trial to test whether this response could be replicated. METHODS: Five adults weight recovered from AN but with persistent eating disorder thoughts and behaviors adopted a therapeutic ketogenic diet (TKD) aimed at maintaining weight. After sustaining nutritional ketosis, participants received six ketamine infusions and were followed over 6 months. RESULTS: All participants completed the study protocol without significant adverse effects. Two participants maintained TKD for 8 weeks prior to ketamine infusions due to good behavioral response and remained on TKD. Three participants received TKD for 4 weeks prior to and during ketamine, then tapered off after the final infusion. The group showed significant improvements on the Clinical Impairment Assessment (p = 0.008), Eating Disorder Examination Questionnaire (EDEQ) Global score (p = 0.006), EDEQ-Eating Concerns (p = 0.005), EDEQ-Shape Concerns (p = 0.016), EDEQ-Weight Concerns (p = 0.032), Eating Disorders Recovery Questionnaire (EDRQ) Acceptance of Self and Body (0.027) and EDRQ-Social and Emotional Connection (p = 0.001). Weight remained stable, except for one participant who relapsed 4 months after treatment and off TKD. CONCLUSION: This novel treatment appears to be safe and effective for adults with chronic AN-related psychopathology. The results from this open trial support that there are specific neurobiological underpinnings of AN that can be normalized using TKD and ketamine. LEVEL OF EVIDENCE: Level IV, multiple time series with intervention.
Authors: Hunna J Watson; Zeynep Yilmaz; Laura M Thornton; Christopher Hübel; Jonathan R I Coleman; Héléna A Gaspar; Julien Bryois; Anke Hinney; Virpi M Leppä; Manuel Mattheisen; Sarah E Medland; Stephan Ripke; Shuyang Yao; Paola Giusti-Rodríguez; Ken B Hanscombe; Kirstin L Purves; Roger A H Adan; Lars Alfredsson; Tetsuya Ando; Ole A Andreassen; Jessica H Baker; Wade H Berrettini; Ilka Boehm; Claudette Boni; Vesna Boraska Perica; Katharina Buehren; Roland Burghardt; Matteo Cassina; Sven Cichon; Maurizio Clementi; Roger D Cone; Philippe Courtet; Scott Crow; James J Crowley; Unna N Danner; Oliver S P Davis; Martina de Zwaan; George Dedoussis; Daniela Degortes; Janiece E DeSocio; Danielle M Dick; Dimitris Dikeos; Christian Dina; Monika Dmitrzak-Weglarz; Elisa Docampo; Laramie E Duncan; Karin Egberts; Stefan Ehrlich; Geòrgia Escaramís; Tõnu Esko; Xavier Estivill; Anne Farmer; Angela Favaro; Fernando Fernández-Aranda; Manfred M Fichter; Krista Fischer; Manuel Föcker; Lenka Foretova; Andreas J Forstner; Monica Forzan; Christopher S Franklin; Steven Gallinger; Ina Giegling; Johanna Giuranna; Fragiskos Gonidakis; Philip Gorwood; Monica Gratacos Mayora; Sébastien Guillaume; Yiran Guo; Hakon Hakonarson; Konstantinos Hatzikotoulas; Joanna Hauser; Johannes Hebebrand; Sietske G Helder; Stefan Herms; Beate Herpertz-Dahlmann; Wolfgang Herzog; Laura M Huckins; James I Hudson; Hartmut Imgart; Hidetoshi Inoko; Vladimir Janout; Susana Jiménez-Murcia; Antonio Julià; Gursharan Kalsi; Deborah Kaminská; Jaakko Kaprio; Leila Karhunen; Andreas Karwautz; Martien J H Kas; James L Kennedy; Anna Keski-Rahkonen; Kirsty Kiezebrink; Youl-Ri Kim; Lars Klareskog; Kelly L Klump; Gun Peggy S Knudsen; Maria C La Via; Stephanie Le Hellard; Robert D Levitan; Dong Li; Lisa Lilenfeld; Bochao Danae Lin; Jolanta Lissowska; Jurjen Luykx; Pierre J Magistretti; Mario Maj; Katrin Mannik; Sara Marsal; Christian R Marshall; Morten Mattingsdal; Sara McDevitt; Peter McGuffin; Andres Metspalu; Ingrid Meulenbelt; Nadia Micali; Karen Mitchell; Alessio Maria Monteleone; Palmiero Monteleone; Melissa A Munn-Chernoff; Benedetta Nacmias; Marie Navratilova; Ioanna Ntalla; Julie K O'Toole; Roel A Ophoff; Leonid Padyukov; Aarno Palotie; Jacques Pantel; Hana Papezova; Dalila Pinto; Raquel Rabionet; Anu Raevuori; Nicolas Ramoz; Ted Reichborn-Kjennerud; Valdo Ricca; Samuli Ripatti; Franziska Ritschel; Marion Roberts; Alessandro Rotondo; Dan Rujescu; Filip Rybakowski; Paolo Santonastaso; André Scherag; Stephen W Scherer; Ulrike Schmidt; Nicholas J Schork; Alexandra Schosser; Jochen Seitz; Lenka Slachtova; P Eline Slagboom; Margarita C T Slof-Op 't Landt; Agnieszka Slopien; Sandro Sorbi; Beata Świątkowska; Jin P Szatkiewicz; Ioanna Tachmazidou; Elena Tenconi; Alfonso Tortorella; Federica Tozzi; Janet Treasure; Artemis Tsitsika; Marta Tyszkiewicz-Nwafor; Konstantinos Tziouvas; Annemarie A van Elburg; Eric F van Furth; Gudrun Wagner; Esther Walton; Elisabeth Widen; Eleftheria Zeggini; Stephanie Zerwas; Stephan Zipfel; Andrew W Bergen; Joseph M Boden; Harry Brandt; Steven Crawford; Katherine A Halmi; L John Horwood; Craig Johnson; Allan S Kaplan; Walter H Kaye; James E Mitchell; Catherine M Olsen; John F Pearson; Nancy L Pedersen; Michael Strober; Thomas Werge; David C Whiteman; D Blake Woodside; Garret D Stuber; Scott Gordon; Jakob Grove; Anjali K Henders; Anders Juréus; Katherine M Kirk; Janne T Larsen; Richard Parker; Liselotte Petersen; Jennifer Jordan; Martin Kennedy; Grant W Montgomery; Tracey D Wade; Andreas Birgegård; Paul Lichtenstein; Claes Norring; Mikael Landén; Nicholas G Martin; Preben Bo Mortensen; Patrick F Sullivan; Gerome Breen; Cynthia M Bulik Journal: Nat Genet Date: 2019-07-15 Impact factor: 38.330
Authors: Barbara Scolnick; Beth Zupec-Kania; Lori Calabrese; Chiye Aoki; Thomas Hildebrandt Journal: Front Psychiatry Date: 2020-07-30 Impact factor: 4.157
Authors: Elisa Brietzke; Rodrigo B Mansur; Mehala Subramaniapillai; Vicent Balanzá-Martínez; Maj Vinberg; Ana González-Pinto; Joshua D Rosenblat; Roger Ho; Roger S McIntyre Journal: Neurosci Biobehav Rev Date: 2018-07-31 Impact factor: 8.989