Anorexia nervosa is difficult to treat, especially in severe and enduring cases. Malnutrition and weight loss can reduce grey and white matter in the brain, impair neuroplasticity and neurogenesis, and cause difficulties with cognitive flexibility, memory, and learning. Depression is highly comorbid and may hinder recovery, but traditional antidepressants are often ineffective in underweight patients. This review presents a conceptual overview for treating anorexia nervosa with ketamine. Ketamine has rapid antidepressant effects hypothesized to occur via increased glutamate, leading to increased neuroplasticity, neurogenesis, and synaptogenesis. The article covers ketamine's use for common psychiatric comorbidities and discusses safety concerns. There appears ample theoretical background to warrant exploring ketamine as a treatment for adults with anorexia nervosa.
Treatment for anorexia nervosa remains challenging due to limited approved medications and variable psychotherapy effectiveness. Converging evidence indicates deficiencies in neuroplasticity during acute stages of the disorder. This review covers neuroimaging, neuropsychological, molecular, and qualitative findings on neuroplasticity in anorexia nervosa. Novel pharmacological approaches that may address these deficits include ketamine, psilocybin, and human recombinant leptin; anti-inflammatory drugs and brain-derived neurotrophic factor mimetics might become viable after further research. Psychotherapeutic strategies targeting neuroplastic deficiencies and broader identity issues include imagery rescripting, memory specificity training, cognitive remediation therapy, exposure therapies, narrative therapies, cultural interventions, and yoga or mindfulness-based approaches. Longitudinal studies with large samples and feasibility trials are needed to advance translation.