Exploring the role of ketamine in eating disorders: a review of emerging evidence

Ketamine acts on the glutamatergic system and has been increasingly studied for its potential therapeutic effect in serious psychiatric disorders. So far, the most compelling evidence for its effectiveness is found in treatment-resistant depression. Other conditions, such as obsessive-compulsive disorder, post-traumatic stress disorder, and suicidal ideation, have also garnered interest, with a growing body of research exploring their clinical use. However, to our knowledge, the therapeutic potential of ketamine in eating disorders (ED) remains a nascent field of inquiry. The identification of new therapeutic approaches for ED is of high clinical relevance, given their elevated mortality rates and frequent medical complications requiring careful clinical management. The aim of this study was to investigate the current evidence on the use of ketamine in ED and to characterize the type and quality of available studies.

A literature review was conducted in PubMed using a predefined search strategy combining terms related to ketamine/esketamine and ED. Studies were screened for relevance, specifically whether they addressed ED and involved ketamine or esketamine. Irrelevant articles were excluded, and the remaining studies were categorized by design: case reports, case series, observational studies, interventional studies, and reviews. A descriptive analysis was performed to summarize study characteristics. A total of 78 articles were identified. Of these, 42 were excluded for not addressing ED or not involving ketamine or esketamine therapy. Among the remaining studies, nine were reviews, eleven were preclinical studies, 13 were case reports or case series, two were observational studies, and one was an interventional study. Overall, 323 participants were included in the review. Notably, 274 of the 323 participants were drawn from two observational studies by Wassenaar et al.: one controlled observational study with 170 participants (85 ketamine-treated and 85 matched controls) and one retrospective observational study with 104 participants without a control group. The only interventional study was a pilot study involving five patients.

The studies analyzed indicate that ketamine is emerging as a promising intervention for ED, particularly anorexia nervosa, by modulating the glutamate system and promoting neuroplasticity. The core findings suggest that the substance can reduce cognitive rigidity and obsessive behaviors, with evidence pointing toward enhanced efficacy when combined with a ketogenic diet or utilized as a catalyst in assisted psychotherapy. Furthermore, research in animal models and clinical case reports highlights ketamine’s potential to foster long-lasting resilience and treat severe comorbidities, such as treatment-resistant depression; however, the literature emphasizes the need for rigorous safety monitoring and larger-scale clinical trials to fully validate these treatment protocols.

Innovative pharmacological approaches represent a potential therapeutic avenue for addressing the complex cognitive patterns associated with ED. While preliminary observations regarding neuroplasticity and integrated psychological interventions are noteworthy, the field requires further empirical validation. Given the clinical complexity of this patient population, future research should transition toward robust, randomized controlled trials. Developing standardized clinical guidelines and tracking long-term safety will be key to making these new ED treatments a viable part of standard care.

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