Of the many things I value about being a clinician who helps persons with eating disorders and their families, the one I perhaps hold most dear is that the clients themselves have been some of my best teachers. I believe in keeping an open mind and being ready to change. A shift that has been happening recently is the use of psychedelic medicines to help with a variety of mental health challenges. Many of these medicines are not legal yet, but the Food and Drug Administration (FDA) has approved trials for them with specific disorders, including a Multi-Site Study for MDMA Assisted Psychotherapy with Eating Disorders.
The Use of Ketamine for Mental Health Challenges
One medicine that is linked to psychedelics that is legal is ketamine, a schedule III medication that is not technically a psychedelic but a dissociative anesthetic known for its psychedelic effects at low doses and when emerging from anesthesia.(1) It is used off-label for the treatment of several mental health challenges, including depression, anxiety, substance use, post-traumatic stress disorder, obsessive compulsive disorder, and suicidality.
My clients and families began asking about ketamine. When I was working at a world-class eating disorders treatment program, my psychiatric colleagues also began using ketamine for eating disorder cases with treatment-resistant depression. At first, I was skeptical, as ketamine is also known as a club drug with potential for abuse. But from listening to my clients and my observation of their recovery journeys, I could see it was helping them.
There is now emerging data and interest in research for the use of ketamine for the treatment of eating disorders.(2) I began to wonder about how to do psychotherapy with the medicine and discovered there was a whole world of ketamine-assisted psychotherapy as well as a very lovely practice of intentional preparation, setting, guided experience, and integration of the medicine experience. Leading the way in this space are Dr. Phil Wolfson, co-author of The Ketamine Papers: Science, Therapy, and Transformation, and his team with Julane Andries at The Center for Transformational Psychotherapy in San Anselmo, CA, where I went to add to my own experiential learning.
They describe how ketamine works using the language below:
“Ketamine, when taken in a psychotherapy session, can be beneficial. The medication can stabilize patients with severe depression swiftly. Scientists from the University of Texas (UT) have identified the key protein that helps activate the rapid antidepressant effects of ketamine in the brain. Their study, published in the journal Nature, revealed that ketamine inhibits a protein responsible for an array of normal brain functions. The medication blocks the N-methyl-D-aspartate (NMDA) receptor, an ion channel protein and glutamate receptor found in nerve cells. Inhibiting NMDA produces an initial antidepressant reaction. A metabolite found in ketamine is responsible for prolonging the effect’s duration.
Stabilization is not the only effect of ketamine depression therapy. The blocking of the NMDA receptor also induces the hallucinogenic responses of ketamine. When taken with proper care, however, the drug may help severely suicidal or depressed patients get effective and fast treatment.”
KRIYA Ketamine Research Institute also has a nice reading list here for more learning.
Ketamine in Eating Disorder Treatment
Because so many of my clients with eating disorders also struggle with co-occurring conditions and the data on ketamine therapy is very compelling, I decided to get training through Polaris Insight Center and offer ketamine-assisted psychotherapy to my treatment of eating disorders. Also notable is that the founder who trained me in Emotion Focused Family Therapy (EFFT), Dr. Adele Lafrance, has developed Emotion Focused Ketamine Assisted Psychotherapy (EFKAP) with Reid Robison, MD. Of course, I was in the first training cohort!
Some of the things I find advantageous about ketamine for eating disorder treatment is that, while other psychedelics may last 6 to 8 hours, ketamine effects range from roughly 45 minutes to 2 hours. I also find it to be a gentle, loving medicine that allows for some respite from deeply-entrenched eating disorder thoughts and access to emotions and the heart space that is often difficult for someone with an eating disorder to reach. Combined with psychotherapy, there is a huge opportunity to get into contact with who and what is important to you and set some goals on how to move in those directions. And, thanks to the EFKAP model, there is inclusion of support persons to learn about the process and assist in at-home dosing.
So that is a long introduction into announcing that Eating Disorder Intervention will now be offering ketamine-assisted psychotherapy in-person in Golden. If you are interested in this therapy for yourself or a loved one, the first step is to reach out to me and discuss the process. Ketamine has some medical and psychiatric contraindications and is not for everyone. We will need to work with a prescribing provider to do an assessment to determine if the medicine would be an option for your situation. If ketamine is a possibility for you, we will take it slow and get to know each other so that you can build a sense of trust and safety to prepare you for what may be a wonderfully transformative experience.
Check out my website or reach out to me via my contact page. I offer free, 30-minute consultations to new clients.
1 Andrew T. Bowdle, Allen D. Radant, Deborah S. Cowley, Evan D. Kharasch, Rick J. Strassman, Peter P. Roy-Byrne; Psychedelic Effects of Ketamine in Healthy Volunteers : Relationship to Steady-state Plasma Concentrations. Anesthesiology 1998; 88:82–88 doi: https://doi.org/10.1097/00000542-199801000-00015
David S. Mathai, MD , Sanjay J. Mathew, MD , Eric A. Storch, PhD , Thomas R. Kosten, MD. Revisiting the Hallucinogenic Potential of Ketamine. June 25, 2018. Psychiatric Times, Vol 35, Issue 6, Volume 35, Issue 6
2 Daniel F. Hermens, Gabrielle Simcock, Megan Dutton, Ana P. Bouças, Adem T. Can, Chris Lilley, Jim Lagopoulos. Anorexia nervosa, zinc deficiency and the glutamate system: The ketamine option. Progress in Neuro-Psychopharmacology and Biological Psychiatry. Volume 101, 2020; 109921, ISSN 0278-5846. https://doi.org/10.1016/j.pnpbp.2020.109921.Esther Dechant, Brian Boyle, Rachel A Ross. Ketamine in a Patient with Comorbid Anorexia and MDD. Journal of Women’s Health and Development 3 (2020): 373-375
Schwartz T, Trunko ME, Feifel D, et al. A longitudinal case series of IM ketamine for patients with severe and enduring eating disorders and comorbid treatment-resistant depression. Clin Case Rep. 2021;9:e03869. https://doi. org/10.1002/ccr3.3869