Anorexia, Ketamine, and the Default Mode Network

Anorexia, Ketamine, and the Default Mode Network

Do you feel good about what you weigh?  Or about how you look?

If you hesitated to answer, you’re not alone. If you answered No…or…I’m not sure… again, you’re not alone.

Survey Says: Majority Don’t Like the Way They Look

Allure, a magazine centered on beauty, surveyed 2,497 people nationwide, and found that 64% of people look at someone and the first thing they notice is how attractive they are.  And 50% said they believed appearance defines us all… Really..? 

Oh, and get this: 62% of both men and women said they believed they were more critical of their own appearance than others are of theirs.

So, being preoccupied with your appearance is not constrained by age or gender. It’s happening in the majority of the population. And who knows how many people surrounded the people in those percentages and criticized them for their weight, their appearance, or their appeal.

Is it any wonder that 30 million people in this country suffer from eating disorders?

30 MILLION !!!

Support for Your Eating Disorder

In the early 1970’s, a nurse named Viv tried to find support for the family of a critically ill patient in her hospital. She was unable to find ANYTHING to offer for connection or support for this patient and her family.

In the process of calling around, one healthcare professional after another told her that Anorexia Nervosa was such a rare disease, there probably weren’t even 2000 people with it in the entire U.S. They said she was wasting her time.

So she decided to research the situation for herself. After all, she was a nurse, and nurses can have some serious determination when it comes to helping their patients.

So she posted an ad in a newspaper…so seventies, right?…just a small block ad. The ad stated she was searching for others interested in information about eating disorders. Her town in Illinois had a population of about 30,000. It was no metropolis.

Well, within a few days she received 8 responses to that ad from people who’d been diagnosed with anorexia or another eating disorder, as well as family and friends who were concerned about a loved one.

But that was just the beginning.

Somehow, as fate would have it, a national magazine got wind of her story and published their own story about her.  When that was published, she was flooded with a deluge of phone calls and letters from people all over wanting to learn more.  She opened her home and established the first national helpline and referral service in the USA for people with eating disorders.

Viv founded ANAD, the National Association of Anorexia Nervosa and Associated Disorders, or ANAD.org.

That small group she started in her home took their training nationwide to establish professional support groups, helplines, and peer-to-peer support groups.

Anorexia, Ketamine, and the Default Mode Network: Mental Health Awareness Month

May is Mental Health Awareness Month, and this is the last post for this month, but going forward our posts will continue to address issues of mental health. Still, it seems fitting that we talk and share information about the deadliest of all psychiatric disorders — and that is eating disorders. Because somehow, it seems this is the quietest…least talked about … but deadliest… disorder of all.

No One is Testing Ketamine for Eating Disorders

Fact: there are currently 188 studies on anorexia nervosa listed in the National Institutes of Health databas, and not one of them is testing the effectiveness of ketamine combined with therapy … which we talked about last week.  Plus, of the 489 studies on eating disorders, none incorporate ketamine treatment in any way.

Here’s what they ARE trying. Things like:

• Warm ginger foot soaks
• Zyprexa, an antipsychotic and mood stabilizer
• Duloxetine, an antidepressant
• Mobile phone apps
• Omega-3
• Deep Brain Stimulation
• Oxytocin

This is despite the high prevalence of suicidal thinking and actual suicide in anorexia. And despite the obsessive thoughts that ravage those who are restricting their food intake. Think about it. 

If you suddenly imposed upon yourself that you were going to eat no more carbs… no potatoes, no bread, no sugar, no chocolate, no sweets, no ice cream…

What do you suppose would be on your mind constantly over the coming days…?

CARBOHYDRATES!

Every commercial on TV would seem to be about ice cream, cake, sugar, chocolate, bread … carbs!  Every thought you have as you listen to your stomach growl…?  French fries, fast food, donuts, dessert ….

Right??

When you deprive yourself, you obsess over how to end that deprivation. And if that’s as true of you as it is the rest of the human race, just imagine what it’s like for someone with an eating disorder.

When you’re sick with an eating disorder, you feel fat, see yourself as fat, and obsess over how to lose weight. And you restrict what you eat, and exercise excessively, or use laxatives or purging to prevent body fat at all costs. Even when you’re not doing anything, your mind is busy thinking, and your thoughts default to counting, criticizing, obsessing about fatness, thinness, calories, food…

Because of that… for anorexia, ketamine and its effects the default mode network could reveal a very effective treatment for eating disorders.

The condition of those with severe eating disorders is critical. Life-threatening – as in death – due to organ failure as well as suicide.

To take it a step further, studies involving the Default Mode Network that goes into play after ketamine infusions to make the most of cognitive behavioral therapy (CBT) are demonstrating some great results for other conditions.

Why isn’t anyone studying that for eating disorders??

The deadliest psychiatric disorder…!

When you look at just the handful of studies above, do you wonder why they’re so diverse…? Is  that there’s so little we have to offer biologically

Don’t you wonder why researchers aren’t JUMPING on studying ketamine treatment for eating disorders every which way but Sunday?

SOMEONE SHOULD DO A STUDY!!

After all, this is exactly how research questions are formed and carried through to studies and trials in search of answers. This is how new ideas spark! And tried and true treatments become established and trusted.

So let’s think about this:

How might ketamine treatment provide the best and most thorough impact to help those with eating disorders?

A study comes to mind that might be extremely useful to consider. Sam Wilkinson and his group at Yale studied the effects of using ketamine treatment and cognitive behavioral therapy (CBT) together to prolong the anti-depressive effects of ketamine.

The study, which took place last year, arranged for depressed patients to undergo 12 CBT sessions over 10 weeks, while also receiving 2 ketamine infusions a week for two weeks.

The results indicated that remission from depression lasted longer in some than others, but in most
cases it lasted longer than it did with ketamine alone.

(Remember the blog about the first international Ketamine Conference in England in March?  He discussed his data at that meeting!)

They used only 4 infusions instead of 6 — a protocol that may be a little underpowered in terms of getting depressive symptoms to completely remit in the first place.  But people who achieve full remission early like that may be more likely to stay in remission…? We’ll see. Perhaps using CBT with strong early remitters allows a cleaner testof whether CBT prolongs remission after ketamine or not. 

So let’s extend this for a moment to eating disorders.

The First Study with Ketamine for a Psychiatric Disorder

Jump back to 1998, and to I.H. Mills, who initiated studies in 1992 to establish eating disorders as compulsive disorders. Mills and his group were the first to study ketamine for treating the compulsiveness in eating disorders in 1998. Which, by the way, was the first study using ketamine to treat a psychiatric disorder ever.

So, I think somebody really should do a study…where 6 infusions of ketamine are used in patients with eating disorders and then 24 hours after each ketamine infusion (more about that in a second), the subject receives cognitive behavioral therapy. …. Or maybe 8 infusions interspersed with CBT, and then 4 more CBT sessions tacked on to the end…?

And what if the response was tracked not just by the usual rating scales for depression and OCD but by additional measures looking specifically at eating disorder symptoms and markers of improvement.. 

Thrilling to think about, isn’t it?

But they could take it even another step further.

Anorexia, Ketamine, and the Default Mode Network

They could exploit the Default Mode Network (DMN) in the brain for that study. If you remember, the Default Mode Network is a network of areas of the brain that work together to give your brain a restful state… where you complete a task you’re focused on, and instantly find yourself day dreaming… musing, reminiscing, worrying…or even obsessing about something negative about yourself, others, the past, or the future. 

A brilliant group of researchers spear-headed by Meng Li of Magdeburg, has discovered through functional MRIs (fMRI) that the functional connectivity of the posterior cingulate gyrus (dPCC) changes after a ketamine infusion. This area is part of the DMN, and it is involved in more negative thought patterns. They see it change in the first hour after the infusion, but the change is much more dramatic after 24 hours. This change increases BDNF – remember what BDNF does?

This changes the glutamate at the NMDA receptors at the AMPA receptors, and the synapses or connections between the cells in the brain proliferate rapidly, budding and branching and quickly improving the communication and movement of signals throughout the brain.

At around 24 hours post-infusion, the functional connectivity of the dPCC is so greatly reduced that the DMN can use other parts of the brain to take over the resting thoughts. And that allows you to consider positive alternatives to the negative obsessing, worry, self-recriminations, and other negative thought patterns.

So when the DMN opens up 24 hours after a ketamine infusion, the neuroplasticity in the brain cells that ketamine sets in motion can help CBT to be much more effective. It’s a potential path to remission… and that’s what we want to find.

Not just for anorexia.  For so much more.

May 2018 Mental Health Awareness Month

Mental Health Awareness Month has been a time of talking, listening, offering patience, and treating those we don’t understand with compassion. In psychiatry and neuroscience, we find more answers about psychiatric disorders to bring relief to more who suffer.

Including those who suffer in the shadows from disorders less understood.

If you’re someone who suffers from an eating disorder, and don’t know what to do, please call us. We’re looking for solutions, and we want to help you, too.

Innovative Psychiatry focuses on successfully treating the seemingly untreatable, most life-threatening psychiatric disorders. We get to see remarkably widespread response and remission in the patients we treat.

And we’re finding that ketamine treatment can smash through even the worst symptoms when administered properly. We’re thrilled when our patients feels restored and resilient. When they feel changed for the better.

When you walk into our office, you’ll be treated with respect, compassion, and support. For your infusion, we offer private, beautiful and relaxing environments.

And within about 6 infusions over 2-3 weeks, you can feel like your brain has been reset. You’ll feel joy…and hope. You’ll find you have more control over your life. And you’ll find you’ve rediscovered your best self. A new you?…more like the real you. Give us a call and let’s talk.

To the fresh emergence of your best self,

Lori Calabrese, M.D.