SUMMARY  

• Keeler et al (2023)¹ published a case series of 4 patients with a diagnosis of anorexia nervosa (AN) and major depressive disorder (MDD) who were treated with either SPRAVATO (n=2) or intramuscular (IM) ketamine (n=2).
  • Results of the 2 patients, with TRD and were treated with SPRAVATO, are summarized below. One patient experienced more improvement in their depressive symptoms than the other. Both slightly gained weight by the end of their treatment.
• Gao et al (2025)² described a case of a patient with treatment-resistant depression (TRD) and comorbid eating disorder (in addition to generalized anxiety disorder, post-traumatic stress disorder and borderline personality disorder) who was treated with SPRAVATO at various times over a 10-year period.
  • The patient was ultimately reported to be relatively stable for more than 2 years.

CLInical data

Keeler et al (2023)¹ published a case series of 4 female Caucasian patients with a diagnosis of AN and MDD who were treated with either SPRAVATO (n=2) or IM ketamine (n=2). Patients had to have a primary diagnosis of MDD and secondary diagnosis of AN and received ≥2 doses of SPRAVATO or IM ketamine. Only the summaries of patients who were treated with SPRAVATO are detailed below.

• A 19-year-old female was diagnosed with AN and TRD.
  • Over a period of 149 days, the patient received a total of 23 doses of SPRAVATO. The dosage was titrated from 56 mg in the first 2 doses to 84 mg in the subsequent doses.
  • The patient reported an initial decrease in depression, which was largely sustained in subsequent dosing sessions. By the end of treatment, the patient’s Patient Health Questionnaire-9 (PHQ-9) score decreased from 15 to 7.
  • No adverse effects were reported during the treatment period.
  • The patient’s weight was 51.1 kg (body mass index [BMI]=21.3 kg/m²) at the first dose, which increased to 54.5 kg (BMI=22.7 kg/m²) by the last dose.
• Another 19-year-old female was diagnosed with TRD and had a historical diagnosis of AN and bulimia nervosa.
  • The patient received 10 doses of SPRAVATO over a period of 43 days. The dose was titrated from 56 mg in the first 2 doses to 84 mg in the third dose, which was then titrated down to 56 mg in the next 7 doses.  
  • Her baseline PHQ-9 was 26. Despite a reported decrease in her depression severity, the PHQ-9 only decreased to a score of 22 by the end of treatment.
  • SPRAVATO was tolerated well, although nausea/vomiting was reported on the seventh dose.
  • The patient’s weight was 50.7 kg (BMI=19.1 kg/m²) at the first dose, which increased to 53.4 kg (BMI = 20.1 kg/m²) by the last dose.
• Gao et al (2025)² described a case-report of an 18-year-old female patient with TRD and comorbid eating disorder, in addition to generalized anxiety disorder, post-traumatic stress disorder and borderline personality disorder who was treated with SPRAVATO.
• In addition to psychotherapy, the patient was previously treated with antidepressants, adjunctive antipsychotics, lithium, lamotrigine, several series of electroconvulsive therapy (ECT), and ketamine as an infusion and compounded intranasal spray.
• She initially received SPRAVATO twice weekly for four weeks followed by weekly administration, in addition to weekly ECT.
  • She had transient benefit with SPRAVATO but relapsed with a serious suicide attempt after stopping treatment.
• SPRAVATO was restarted following a residential treatment for her eating disorder (56 mg for the first session increasing to 84 mg for subsequent sessions, twice weekly for four weeks). The patient missed her second weekly SPRAVATO session and experienced a relapse, resulting in hospitalization.
• During the hospitalization, SPRAVATO was resumed twice a week for two weeks and then once weekly. The patient’s mood has remained relatively stable with ongoing weekly SPRAVATO treatments for more than 2 years.

Literature Search

A literature search of MEDLINE^®, Embase^®, BIOSIS Previews^®, Derwent Drug File (and other resources, including internal/external databases) was conducted on 30 June 2025.

REFERENCES

1. Keeler J, Treasure J, Himmerich H, et al. Case report: Intramuscular ketamine or intranasal esketamine as a treatment in four patients with major depressive disorder and comorbid anorexia nervosa. Front Psychiatry. 2023;14:1181447.

2. Gao K, Koparal B, Oruc EB, et al. Electroconvulsive Therapy, Ketamine, and Esketamine in a Patient with Major Depressive Disorder and Multiple Comorbidities: A Case Report over 10-year Treatment from Adolescence to Adulthood. Psychopharmacol Bull. 2025;55(3):44-55.