Ketamine for Eating Disorders: Emerging Evidence and Future Directions

Introduction

Eating disorders such as anorexia nervosa and binge eating disorder are notoriously difficult to treat. In their 2022 publication in Brain Sciences, Ragnhildstveit et al. discuss the potential of ketamine as a novel psychopharmacological intervention for eating disorders. This narrative review examines current evidence and outlines areas for future exploration.

Key Points

1. Mechanism of Action:
   • Ketamine’s NMDA receptor antagonism and downstream effects on glutamatergic pathways are hypothesized to:
     • Reduce hyperactivity in neural circuits associated with obsessive-compulsive behaviors.
     • Promote neuroplasticity, potentially resetting maladaptive eating behaviors.
2. Clinical Observations:
   • The review highlights case reports and small trials suggesting ketamine may alleviate:
     • Ruminative thoughts related to body image.
     • Emotional dysregulation tied to disordered eating.
3. Applications Across Disorders:
   • Potential indications include:
     • Anorexia Nervosa: Reducing cognitive rigidity and improving response to therapy.
     • Binge Eating Disorder: Mitigating compulsive behaviors and emotional triggers.
4. Limitations:
   • Limited sample sizes and lack of randomized controlled trials hinder definitive conclusions.
   • Long-term safety and optimal dosing regimens remain unclear.
5. Future Directions:
   • Larger clinical trials are necessary to validate efficacy and identify patient subpopulations most likely to benefit.

The VitalPoint For Providers

Ketamine presents an innovative, mechanistically novel option for eating disorders, addressing key neurocognitive and behavioral challenges. As evidence accumulates, it could supplement or enhance existing therapies. Clinicians should monitor emerging data to determine its clinical viability and integration into treatment frameworks.