Psychedelics and Eating Disorders
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A presentation I gave on Nov 18, 2021 for Mind Medicine's International Summit focused on how psychedelics are being used clinically and in research setting to treat eating disorders such as anorexia nervosa, bulimia, and binge eating disorder.
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Psychedelics and Eating Disorders
- 1. Psychedelics & Eating Disorders 18 Nov 2021 Reid Robison MD MBA Chief Medical Officer, Novamind Adjunct Faculty, University of Utah
- 2. Mind Medicine | November 2021 "I’m tempted to say MDMA gave me ‘hope,’ but that word isn’t right: the insight was more substantive than hope. I’d held the sensation in my body; I understood, at a visceral level, what might someday be mine: the sense of peace and joy within my body. For me, the therapeutic process could unfurl from there.” MDMA Study Participant
- 3. Mind Medicine | November 2021 Challenges in Eating Disorder Treatment The Potential of Psychedelic Medicine for Eating Disorders Ketamine/Esketamine (G-KAP, EF-KAP, IM Ketamine, Spravato) MDMA-assisted Psychotherapy for AN & BED (with caregiver involvement) Psilocybin + IFS for Eating Disorders Presentation Outline
- 4. Challenges in Eating Disorder Treatment
- 5. Mind Medicine | November 2021 Eating disorders are in desperate need of new treatments. No FDA-approved medications exist for Anorexia. We need a sense of urgency with screening/dx/tx—we often don’t act quickly enough: “Ok you’ve missed one period, why don’t you come back if you’ve missed another period or two…” ← We don’t do that in cancer treatment. We’d never dream of saying: “Ok your cancer is a stage 1. Why don’t you come back when it’s stage 2 or 3.” And yet we do that with eating disorders. These are serious conditions and sometimes immediate care is needed. Don’t wait to treat until full medical workup is done and diagnosis is crystal clear: “We’re still waiting for thyroid tests, celiac disease, etc., etc. But I need to be clear that the most common reason that your child is having these symptoms is an eating disorder.” Sometimes we need to think outside the box and venture into the unknown in search of new treatment options for our clients. Challenges in eating disorder treatment
- 6. Mind Medicine | November 2021 The potential to alleviate symptoms that relate to serotonergic signaling and cognitive inflexibility The induction of desirable brain states that might accelerate therapeutic processes 01 02 How might psychedelics help with eating disorders?
- 7. Ketamine
- 9. Mind Medicine | November 2021 NMDA Receptor Blockade Mechanism Blocks NMDA receptors, leading to GABAergic inhibition and a surge of glutamate release. Effect Rapid improvements in mood by restoring glutamatergic signaling Analogy Wakes up dormant neurons like jump starting a car battery; lets them communicate freely
- 10. Mind Medicine | November 2021 Lateral Habenular Burst Mode Mechanism Turns off “burst mode” in the lateral habenula (the “anti- reward” center) Effect A break from stress mode: facilitates emotion processing, reduces avoidance of negative affective states Analogy Giving a dose of ketamine is like extinguishing the “fire” of stress in the brain
- 11. Mind Medicine | November 2021 BDNF & Neuroplasticity Mechanism Stimulates BDNF, leading to neurogenesis & new connections Effect Neuron growth & a window of opportunity for deep therapeutic work (neuroplasticity), including: making new connections and strengthening connections Analogy Ketamine is like a fertilizer for neurons *Ideally done during the 24-48 hour window of optimal neuroplasticity after ketamine dosing
- 12. Mind Medicine | November 2021 Brain activity is reduced in depression. Non-Depressed A PET scan measures vital functions such as blood flow, oxygen use, and blood sugar (glucose) metabolism. Source: Mark George M.D. Biological Psychiatry Branch Division of Intramural Research Programs, NIMH 1993 Depressed
- 13. Mind Medicine | November 2021 Limbic/Cortical Interruption Mechanism Interrupts connection between cortex & limbic system Effect Time out from ordinary mind (decreased rumination), down regulation of default mode network (DMN), increased cognitive flexibility Analogy Rebooting your computer
- 14. 3 ways we’re studying ketamine/Spravato for eating disorders…
- 15. Group-Based Ketamine-Assisted Psychotherapy (G-KAP) for eating disorders in a residential treatment setting Novel group-based KAP protocol developed and tested out at a residential eating disorder treatment center: Groups of 4 adults per week, with group preparation, group processing/integration, along with individual integration sessions Collaborative care model with G-KAP integrated with multidisciplinary tx team (including medical, dietary, specialized ED therapy, family therapy, etc.) Study outcomes: Improvements seen in depression and anxiety (PHQ-9 and GAD-7 scores) G-KAP was well-tolerated and safe Feasibility of implementing G-KAP for patients in residential treatment center Cost reduction when using a group-based format Paper submitted for publication – currently in review
- 16. Mind Medicine | November 2021 G-KAP for eating disorders: Results Figures: Mean pre-dose and 4-hour post dose PHQ-9 and GAD-7 scores for the 5 participants receiving IM ketamine treatment across the 4-week study period PHQ-9 = Depression score GAD-7 = Anxiety score Mean 4-hour post-dose survey scores Mean pre-dose survey scores
- 17. Mind Medicine | November 2021 “Trying ketamine allowed me to see the possibility of a life I could have. While the effects did not last, my very first experience snapped me out of a state of life-long, deep disconnection that I didn't even know I had been experiencing. Suddenly, I was able to live in the world in the way people had always described it. Though I am still trying to figure out how to attain that level of connection after catching a glimpse, that one experience was so essential. I could finally feel hunger and fullness cues. I felt what it's like to live in a body, instead of living a short distance from it. I felt connected to others and genuinely cared about their well- being. I felt human for the first time in a long time.” G-KAP Study: Participant Feedback
- 18. The development & feasibility study of a treatment modality for Anorexia: EF-KAP Focuses on developing of skill and confidence with emotion processing. This increases self-efficacy with moving through stress/distress. Also emphasizes the benefit of caregiver support and involvement. REID TO ADD RATIONALE Protocol Preparation (2-3 session – with caregiver involvement if appropriate) Ketamine dosing: Intention setting pre-ketamine, and processing post-ketamine Caregiver skills development: Emotion coaching sessions provided to caregivers concurrently Integration (1-2 session – with caregiver involvement if appropriate)
- 19. Mind Medicine | November 2021 Guiding Principles of Emotion- Focused Ketamine-Assisted Psychotherapy (EF-KAP) This model aims to increase overall self-efficacy with emotion processing thus enabling lasting symptom relief. Every aspect of the treatment is guided by two principles: 01 02 Leveraging the healing power of family • By providing education and skills to a support person thereby: • Strengthening meaningful relationships • Creating a recovery-friendly environment outside of the therapy office • Extending healing beyond the individual Supporting the emotional health of the patient • By focusing on the development of skill and confidence with emotion processing • By focusing on transforming emotion with emotion
- 20. Mind Medicine | November 2021 EF-KAP 15-day (short-term) protocol Visit 1 Monday Preparation session – Psychoeducation re: emotion focus and ketamine (+Caregiver) Visit 2 Wednesday Dosing session #1 (similar to KAP) Visit 3 Thursday Psychotherapeutic integration (with a focus on self-interruption or self-criticism) Visit 4 Monday Dosing session #2 (similar to KAP) (+Caregiver, optional) Visit 5 Tuesday Psychotherapeutic integration (with a focus on healthy anger/assertion) Visit 6 Thursday Dosing session #3 (similar to KAP) (+Caregiver, recommended) Visit 7 Friday Psychotherapeutic integration (with a focus on self-compassion) Visit 8 Monday Closing session (+Caregiver, for full or half-session)
- 21. Mind Medicine | November 2021 Real-world data on ketamine / esketamine & eating disorders We conducted two separate real-world, retrospective analysis of clinical data from our Cedar Psychiatry clinics. Included 623 patients receiving IM ketamine or Spravato nasal spray for depressive disorders. Study measures: Detailed demographic characteristics Clinical characteristics Treatment patterns (frequency, days between sessions, etc.) Clinical outcomes: depression & anxiety scores (PHQ-9 and GAD-7) Safety, tolerability, and adverse events Cost of care Esketamine study submitted for publication – currently being reviewed. IM ketamine study to be submitted this month. Cost-effectiveness analysis completed – manuscript draft underway.
- 22. IM ketamine & esketamine results Neither population experienced significant safety or tolerability issues. These populations had several physical and mental health comorbidities and high exposure to psychiatric medications. In both retrospective analyses, we observed clinically meaningful improvements in depressive and anxiety symptoms as measured by the PHQ-9 and GAD-7 survey instruments (p<.001). Esketamine Mean Depression & Anxiety Scores at Baseline and Last Treatment 0 10 20 30 Mean PHQ-9 Mean GAD-7 Last Treatment Baseline IM Ketamine Depression & Anxiety Scores at Baseline and Last Treatment 0 10 20 Mean PHQ-9 Mean GAD-7 Last Treatment Baseline
- 23. Depression scores in clients with eating disorders before and after ketamine or esketamine treatments *Significant reduction in PHQ-9 scores on paired samples t-test **Eating disorders included: anorexia, bulimia, binge-eating disorder, and a diagnosis of eating disorder unspecified/not otherwise specified
- 24. MDMA
- 25. Mind Medicine | November 2021 MED1: An Open-Label, Multi-Site Phase 2 Study of the Safety and Feasibility of MDMA-Assisted Psychotherapy for Eating Disorders 12 participants with Anorexia Nervosa 6 participants with Binge Eating Disorder Protocol: Weeks 1-3: three participant preparatory sessions (individual and with caregiver) Weeks 4-12: Three 8-hour experimental sessions Six individual integration sessions Three individual + caregiver integration sessions MDMA-assisted psychotherapy for Anorexia Nervosa & Binge Eating Disorder
- 26. Mind Medicine | November 2021 Why MDMA for eating disorders? TRUST: MDMA increases oxytocin levels, which may strengthen the therapeutic alliance FEAR REDUCTION: MDMA increases ventromedial prefrontal activity and decreases amygdala activity, which may improve emotional regulation and decrease avoidance 01 02 EMOTIONAL ENGAGEMENT: MDMA increases norepinephrine release and circulating cortisol levels, which may facilitate emotional engagement and enhance extinction of learned fear association 03
- 27. Psilocybin
- 28. Mind Medicine | November 2021 It’s not about the food Disordered eating thoughts & behaviors are often ways to deal with the experiences in our life that overwhelm us with fear, grief, shame and other emotional pain. IFS is a form of psychotherapy developed by Richard Schwartz in his therapy sessions with individuals with eating disorders. It acknowledges the innate multiplicity of the mind and starts from the premise that the mind is composed of relatively distinct subpersonalities or "parts“, i.e. self critical voices, pessimism… There are 3 categories of parts Exiles: Hold onto the burdens of trauma Managers: Take proactive measures to prevent activation of exiles and encounters with similar painful situations. ex parts that "manage" food intake, sleep, public perceptions, self critical voices, pessimism etc. Firefighters: Soothe exiles when they are activated. They use tools like food, drugs, meditation, exercise, sex etc. to sooth activated or disrupted systems. Rationale for IFS + Psilocybin
- 29. Planned feasibility study: IFS + psilocybin for eating disorders Outcome measures: Safety and tolerability (vitals, ECG, adverse events) Exploring preliminary eating disorders outcomes & changes in functioning 2 group therapy preparation sessions Group dosing session 2 group integration sessions 3 follow-up group therapy sessions Study Design: Group therapy preparation, dosing, integration, and follow-up
- 31. The potential of psychedelics for eating disorders Psychedelics, psychotherapy & psychotropics don’t need to be mutually exclusive in eating disorder treatment Consider them adjunctive, to reduce fears related to recovery, increase flexibility and openness so that ED-specific interventions are easier to receive Though psychedelics may be generally safe from a medical perspective, careful medical and psychological screening and monitoring is important In my opinion, it’s a worthwhile pursuit: I’ve witnessed first-hand the powerful healing that can occur for those suffering from mental health issues and for whom conventional methods have not been effective
- 32. New possibilities along the road to full recovery I’ve witnessed time and time again the extent to which the field is made up of caring, compassionate and hardworking clinicians working hard on behalf of those suffering and their families. And one thing we can all agree on is that despite our best efforts, there remains a need for innovative treatment strategies to serve those for whom conventional treatments have been insufficient, ineffective or even harmful. Although much more research is needed to better understand the safety and efficacy of psychedelic medicines in eating disorders, we feel it is a very worthwhile pursuit. One thing is clear to us, however, and that is the importance of coordinating these efforts with conventional treatment approaches. By doing so, we can build on the decades of research and clinical practice that have shaped treatment delivery across the spectrum of eating disorders, including psychedelic psychotherapy as another treatment ingredient for those for whom it might be appropriate. I have tremendous hope that psychedelic medicine can alleviate suffering for many along the continuum of recovery and their families and we look forward to sharing the results of our studies as they become available.
- 33. Thank you
Notas do Editor
- - I'm Reid Robison, Chief Medical Officer at Novamind. thank you for having me. - Honor to be attending this exciting and timely event.
- Though theoretical mechanisms of action of psychedelic medicines are still being investigated, a growing body of research points towards the following ways psychedelics might help individuals with eating disorders in particular: Classic psychedelics - like psilocybin, LSD and ayahuasca - are thought to interrupt what is called the default mode network (DMN), which is often considered the neurobiological seat of the “ego” in the brain. The DMN is a collection of pathways that govern our self image, our autobiographical memories, and our deeply ingrained beliefs and thought patterns. While results from brain imaging studies in eating disorders are diverse, findings seem to converge on a common theme of over-activity in the default-mode network, showing up in our clients as rumination over caloric intake and food rules, compulsive exercise or eating behavior patterns, body checking, etc. And, like a ski slope, the mind develops and strengthens pathways as we repeat patterns. Every time the thoughts and actions are engaged, the grooves get deeper and deeper, and before long, no matter where we start, we’re likely to slip into the same ruts, and end up following the same path down the mountain. When a psychedelic medicine is ingested, the default-mode network is down-regulated, and it’s like the mind benefits from a fresh coat of powder. This fresh coat of powder provides a blank slate - offering a welcome break from the eating disorder patterns, allowing for increased connectivity between other neuronal networks, and creating the potential to move beyond self-imposed limitations that can be so debilitating in those affected. In other words, the individual has the opportunity to travel down a new set of tracks, allowing them to consciously chart a course that isn’t governed entirely by eating disorder thoughts and urges. The second theorized mechanism in support of psychedelics as a treatment tool for eating disorders involves the way in which psychedelics can help foster desirable brain states that might accelerate therapeutic processes. Specifically, the increased neuroplasticity observed with classic psychedelics and ketamine can also be leveraged in the context of psychotherapy. For example, when we use ketamine as a treatment for eating disorders, we schedule psychotherapy sessions within the 24-48 hour window of potential for neurogenesis to optimize outcomes. Also facilitative in the therapy setting, MDMA, while not a classic psychedelic, is unique among consciousness-altering substances in its ability to promote acceptance of and empathy for self and others. In addition to elevating oxytocin levels, MDMA stimulates the release of the monoamines serotonin, norepinephrine and dopamine, resulting in an improved mood and increased sociability. Brain imaging after administering MDMA shows decreased amygdala activation, and the reduced fear response that follows allows the client to emotionally engage in therapy without becoming overwhelmed by anxiety or negative affective states.
- “[Ketamine] can enhance access to the psyche through enhanced self-awareness and a reduction of ego defenses. These medicines can help individuals break free of self-created barriers or access repressed traumas. In so doing our profession moves from a dose dependent daily suppression of the psyche (conventional psychiatric medications) to an episodic catalyst that tries to peer deeply into the psyche and allow it to be seen and more fully experienced (the psychedelic session). The medication opens the psyche to exploration by removing barriers. The use of evocative tools like ketamine and classic psychedelics run counter to all that conventional psychiatrists have been taught for decades. Medication can enhance access to the psyche instead of merely suppressing symptoms.” (Shannon, 2020)
- The NMDA channel can be thought of as a gate for calcium ions, regulating the rate at which new thoughts are produced in the brain. At excessive rates of NMDA activity, thoughts and the rate at which new thoughts are generated (ideation) is slowed, thus reducing rumination. When the NMDA channel is blocked, thoughts are generated rapidly and, often incoherently, leading to hallucinations and psychosis (which is why there’s an upper limit to a ‘useful’ dose range in psychiatry).
- The lateral habenula connects the limbic system (which processed emotions) and inhibits positive emotions (i.e. blocks pleasurable chemical messengers such as serotonin and dopamine). Depression is like a kink in a hose, where the flow of pleasure and joy is blocked, but ketamine rapidly unkinks the hose, to let these chemical messengers flow
- https://www.frontiersin.org/articles/10.3389/fncel.2020.00082/full BDNF promotes neuron growth (neurogenesis; long term potentiation) Neurotrophic hypothesis of depression: Repeated stress prunes neuron Ketamine can improve the abnormal plasticity of glutamate synapses “When this promoted state of plasticity is combined with rehabilitation, plastic networks can reorganize so that impaired vision of one eye, due to developmental visual deprivation, can be fully restored (Castrén and Kojima, 2017).” KAP is like doing this medication + rehabilitation, but for mental health. Gene-environment interactions Patients with the short (S) variant tri-allelic polymorphisms of the serotonin transporter gene (5-HTTLPR) promoter region were more likely than those with only one risk factor (genetic or environmental) to have smaller hippocampal volumes when experience childhood stress (Frodl et al., 2010).
- When I conducted a pilot study of group-based KAP at an eating disorder treatment center here in utah a couple of years ago, it was easier than I though to integrate into conventional treatments. It was also very well received by participants, AND personally and professionally meaningful to me. I learned a lot about both the power of the group format, AND how to do things better. We’re working on writing up the manuscript for publication, but as a spoiler I’ll just say that we saw improvements in both depression and anxiety, in individuals with serious eating disorders, at a high level of care. we’ve also done a pilot of group based KAP for PTSD, And clinically, in addition to groups for psychotherapeutic integration, we’re working on the logistics of how to roll this out as an option for clients. Unique healing properties in group-based psychotherapies There are certain universal assumptions that underlie group therapy interventions Group experience is universal and leads to reductions in stigma Group therapy is used to bring about changes in attitude and behaviour Groups produce change which is more permanent Groups act as instruments for helping others Through groups, people can grow together, treatment engagement is stronger It is easier to support healing in people when in groups
- Study of 5 participants receiving IM ketamine treatment across the 4-week study period Significant reductions in GAD-7 and PHQ-9 scores as the study progressed.
- Because eating disorders are so difficult to treat, Dr. Adele Lafrance and I designed this study specifically for patients with eating disorder. EF-KAP builds on the principles of Emotion-Focused Therapy (EFT) as well as ketamine-assisted psychotherapy (KAP).
- A new development in the field of psychotherapy is the attention paid to the role of caregivers in the treatment of mental health issues across the lifespan. Caregivers, including parents and partners, represent an often-untapped resource for enhancing change in individuals who struggle with mental health issues. Aside from the fact that caregivers know their loved ones best, and love them the most, there are also a number of practical reasons for the involvement of caregivers. First, those who struggle with behavioral or mental health issues often live at home, with a spouse or partner, or are dependent on their families in some way. Therefore, it is sensible to equip these individuals with evidence-based support skills for use in day-to-day interactions. When caregivers can offer support in the real-world settings where their loved one is most likely to struggle, outcomes also improve. Providing the caregiver with an active role in the service of their loved one’s healing also decreases their feelings of powerlessness and paralysis, which can lead to burn-out, relationship strain, and the possible maintenance of their loved one’s symptoms. There is strong data relating to the cost-effectiveness and the efficacy of structured family involvement and yet the treatment offered to many is individually focused, especially among adolescent and adult populations. This is also true in the context of psychedelic psychotherapies, where with few exceptions, research studies and treatment models focus on the “identified client”. This talk will introduce three models of family-based psychedelic medicine. The first model involves the recruitment of caregivers who learn specific skills to support their loved one throughout the course of psychedelic-assisted psychotherapy, creating an optimal home environment for healing and growth, and reducing the likelihood of problematic relational patterns that could interfere with treatment / outcomes. The second model involves the recruitment of caregivers who participate in medicine sessions alongside their loved one, thereby leveraging the neurobiological bond to deepen the process of healing and growth, including attending to relational patterns that may be reinforcing symptoms. The third model involves caregivers who participate in psychedelic-assisted psychotherapy on behalf of their loved one, who for medical or psychiatric reasons cannot participate themselves. Examples from research settings and anecdotal reports will be provided to illustrate each of these models. This focus on the engagement of caregivers as an extension of the therapist(s) can represent a departure from conventional methods, in particular when clients are adults. However, given the dearth of services available to those struggling – whether due to psychological or financial barriers, the model offers the possibility of filling important gaps in the mental health care system. More importantly, given that outcomes are improved for all involved in treatment efforts, family-based models of psychedelic-assisted psychotherapy offer the possibility of healing that extends far beyond the “identified client”, offering healing for broader systems and communities, and potentially interrupting intergenerational cycles of pain.
- EF-KAP can be utilized as both a short-term intensive treatment and a long-term treatment. For example, we recently delivered a family-based treatment in clinic out here in Utah, using this model #2 where all family members participated in medicine sessions With the goal of healing and growth for the entire family unit, this was an incredibly rewarding process to participate in, And was so touching to see caregivers not only supporting their loved one throughout the course of treatment, but also bravely participating with them, doing the work hand in hand, This added a level of connection in the system that I have never seen before in treatment -- and.. We hope… reducing the likelihood of problematic relational patterns that could interfere with treatment goals and successful outcomes. A new development in the field of psychotherapy is the attention paid to the role of caregivers in the treatment of mental health issues across the lifespan. Caregivers, including parents and partners, represent an often-untapped resource for enhancing change in individuals who struggle with mental health issues. Aside from the fact that caregivers know their loved ones best, and love them the most, there are also a number of practical reasons for the involvement of caregivers. First, those who struggle with behavioral or mental health issues often live at home, with a spouse or partner, or are dependent on their families in some way. Therefore, it is sensible to equip these individuals with evidence-based support skills for use in day-to-day interactions. When caregivers can offer support in the real-world settings where their loved one is most likely to struggle, outcomes also improve. Providing the caregiver with an active role in the service of their loved one’s healing also decreases their feelings of powerlessness and paralysis, which can lead to burn-out, relationship strain, and the possible maintenance of their loved one’s symptoms. There is strong data relating to the cost-effectiveness and the efficacy of structured family involvement and yet the treatment offered to many is individually focused, especially among adolescent and adult populations. This is also true in the context of psychedelic psychotherapies, where with few exceptions, research studies and treatment models focus on the “identified client”. This talk will introduce three models of family-based psychedelic medicine. The first model involves the recruitment of caregivers who learn specific skills to support their loved one throughout the course of psychedelic-assisted psychotherapy, creating an optimal home environment for healing and growth, and reducing the likelihood of problematic relational patterns that could interfere with treatment / outcomes. The second model involves the recruitment of caregivers who participate in medicine sessions alongside their loved one, thereby leveraging the neurobiological bond to deepen the process of healing and growth, including attending to relational patterns that may be reinforcing symptoms. The third model involves caregivers who participate in psychedelic-assisted psychotherapy on behalf of their loved one, who for medical or psychiatric reasons cannot participate themselves. Examples from research settings and anecdotal reports will be provided to illustrate each of these models. This focus on the engagement of caregivers as an extension of the therapist(s) can represent a departure from conventional methods, in particular when clients are adults. However, given the dearth of services available to those struggling – whether due to psychological or financial barriers, the model offers the possibility of filling important gaps in the mental health care system. More importantly, given that outcomes are improved for all involved in treatment efforts, family-based models of psychedelic-assisted psychotherapy offer the possibility of healing that extends far beyond the “identified client”, offering healing for broader systems and communities, and potentially interrupting intergenerational cycles of pain.
- there is currently limited real-world and long-term data for patients receiving IM (intramuscular) ketamine and esketamine nasal spray. We took a look at detailed demographic/clinical characteristics, treatment patterns, clinical outcomes, adverse events, and cost of care of psychiatric patients receiving either IM ketamine therapy or esketamine therapy at private outpatient psychiatric clinics across Utah. These retrospective data analyses were conducted with approval from the University of Utah IRB using de-identified data from the electronic health record system at Cedar Psychiatry clinics (Novamind). In the IM ketamine data analysis, there are 452 adult (ages 18 and older) patients who received ketamine treatment by IM administration from January 2018 to June 2021. The esketamine data analysis includes 171 adults (18 years or older) with TRD and a prescription order for esketamine from July 2019 to June 2020.
- For IM ketamine, average PHQ-9 and GAD-7 scores at baseline (PHQ-9: mean=15.5, SD=6.7; SI: mean=1.06, SD=1.09; GAD-7: mean=12.4, SD=5.7) were significantly reduced at the last IM ketamine treatment (PHQ-9: mean=11.6, SD=6.3; SI: mean=0.65, SD=0.84; GAD-7: mean=8.9, SD=5.8). For intranasal esketamine, the same measurements (PHQ-9: mean=16.7, SD=5.8; GAD-7: mean=12.0, SD=5.8) were found to be significantly lower at the last available treatment (PHQ-9: mean=12.0, SD=6.4; GAD-7: mean=8.7, SD=5.6). In both retrospective analyses, we observed clinically meaningful improvements in depressive and anxiety symptoms as measured by the PHQ-9 and GAD-7 survey instruments (p<.001).
- Esketamine and IM ketamine: All EDs = 28 pts Anorexia = 8 pts Bulimia = 4 pts BED = 7 pts
- AN-R and BED will be the focus of this pilot study due to the great need for effective treatments. Anorexia nervosa (AN) among adults with more chronic symptomology is often resistant to recommended treatments and associated with poor outcomes [1]. Furthermore, completion rates for existing AN treatments are often low. Among adults with BED, approximately 41 to 60% of individuals who receive treatment for BED continue to experience binge-eating symptoms after treatment [3]. While new and innovative treatments are also needed for Anorexia Nervosa binge-purge subtype and Bulimia Nervosa, medical complications related to serious patterns of purging may increase the risk of interaction with the drug and therefore this study will first explore the safety and feasibility of a MDMA-assisted psychotherapy protocol with AN-R and BED.
- A couple main categories: Helps your brain – DMN, cognitive flexibility, neuroplasticity Helps the therapy process - approaching previously unmanageable emotions — therapeutic alliance — inner critic / increased self-compassion MDMA, while not a classic psychedelic, is unique among consciousness-altering substances in its ability to promote acceptance of and empathy for self and others. In addition to elevating oxytocin levels, MDMA stimulates the release of the monoamines serotonin, norepinephrine and dopamine, resulting in an improved mood and increased sociability. Brain imaging after administering MDMA shows decreased amygdala activation, and the reduced fear response that follows allows the client to emotionally engage in therapy without becoming overwhelmed by anxiety or negative affective states.
- Thank you for listening.
- The “problem” in eating disorders is not just about food, eating habits, or weight. It’s a coping response we have to past trauma, shame and anxiety. We develop these harmful habits — such as eating in a disordered way — to deal with the experiences in our life that overwhelm us with fear, grief, shame and other emotional pain. Internal Family Systems (IFS) revolves around the idea that all of us have many “parts” or inner personalities, and that each part has its own individual way of handling various situations to manage the system (ourselves) as a whole. The three main roles of the “parts” that exist within us from an IFS perspective are managers, firefighters, and exiles: The managers create stability and run our day-to-day lives. These parts are proactive and encourage forward movement, striving and want us to improve. They try to maintain control of each situation and relationship we encounter through behaviors such as perfectionism, people pleasing, controlling, judging, and criticizing. (If I do everything right, I’m not a horrible person.) The firefighters or distractors are reactive and try to make us shift gears and balance other parts in the system. These parts protect us by “extinguishing” our harmful feelings, through unhealthy behaviors, including disordered eating, self-harm, and drug abuse. (I’m getting relief now before I lose it.) The exiles are the parts of us that have experienced trauma and carry burdens, and often become isolated within the system in order to protect us from feeling pain, fear, shame and other negative emotions. In addition to these three parts is the Self (with a capital “S”), which resides within each of us. Our Self is our true, unburdened, and self-assured soul, and cannot be damaged by experience. According to IFS founder Richard Schwartz, the Self has “8 C’s”: calmness, curiosity, clarity, compassion, confidence, creativity, courage, and connectedness. IFS and Psilocybin are a promising pair because IFS offers a great tool for preparation and integration of Psychedelic experiences. People often experience a de-polarization of their inner systems and a recovery of a connection to Self often that is permanent. By giving people the language and tools of IFS they can get more out of their psychedelic experiences and heal more comprehensively.
- Thank you for listening.
- Thank you for listening.