Ketamine as a Treatment for Anorexia Nervosa: A Narrative Review

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.

Comment on Keeler et al. Ketamine as a Treatment for Anorexia Nervosa: A Narrative Review. Nutrients 2021, 13, 4158

“…Keeler et al consider the case of using ketamine, currently approved for treatment- resistant depression, as a therapeutic option for severe, enduring AN, and describe the glutamergic and neuroplastic effects of the drug [ 4 ]. Taking this line of thought further, one could also consider the possible trial of other glutamatergic agents as effective for eating disorders, which could be lamotrigine, or vortioxetine.…”

Nutrient Intake and Dietary Inflammatory Potential in Current and Recovered Anorexia Nervosa

“…A comorbid depressive disorder may be a barrier to recovery from AN. Therefore, medications such as ketamine and esketamine which do not rely on the availability of amino acids have been suggested as treatment options for the treatment of a comorbid depressive disorder in malnourished patients with AN [82].…”

A case series of group-based ketamine-assisted psychotherapy for patients in residential treatment for eating disorders with comorbid depression and anxiety disorders

“…In fact, Fewell et al [ 29 ] recommend a focus on depressive and worry symptoms among ED patients in higher levels of care on the basis of their research which showed that these features predicted higher levels of ED symptomatology and psychological impairment at discharge and at 1-year follow-up. This is important when considering the lack of reliable responses to treatment and high relapse rates among those who suffer from EDs [ 22 , 30 , 31 ].…”