Ketamine as a Treatment for Anorexia Nervosa: A Narrative Review

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.

Study at a glance

Abstract

Anorexia nervosa (AN) is a highly complex disorder to treat, especially in severe and enduring cases. Whilst the precise aetiology of the disorder is uncertain, malnutrition and weight loss can contribute to reductions in grey and white matter of the brain, impairments in neuroplasticity and neurogenesis and difficulties with cognitive flexibility, memory and learning. Depression is highly comorbid in AN and may be a barrier to recovery. However, traditional antidepressants are often ineffective in alleviating depressive symptoms in underweight patients with AN. There is an urgent need for new treatment approaches for AN. This review gives a conceptual overview for the treatment of AN with ketamine. Ketamine has rapid antidepressant effects, which are hypothesised to occur via increases in glutamate, with sequelae including increased neuroplasticity, neurogenesis and synaptogenesis. This article provides an overview of the use of ketamine for common psychiatric comorbidities of AN and discusses particular safety concerns and side effects. Potential avenues for future research and specific methodological considerations are explored. Overall, there appears to be ample theoretical background, via several potential mechanisms, that warrant the exploration of ketamine as a treatment for adults with AN.