Abstract
Eating disorders (EDs) are serious, life-threatening psychiatric conditions associated with physical and psychosocial impairment, as well as high morbidity and mortality. Given the chronic refractory nature of EDs and the paucity of evidence-based treatments, there is a pressing need to identify novel approaches for this population. The noncompetitive N-methyl-D-aspartate receptor (NMDAr) antagonist, ketamine, has recently been approved for treatment-resistant depression, exerting rapid and robust antidepressant effects. It is now being investigated for several new indications, including obsessive–compulsive, post-traumatic, and substance use disorder, and shows transdiagnostic potential for EDs, particularly among clinical nonresponders. Hence, the aim of this review is to examine contemporary findings on the treatment of EDs with ketamine, whether used as a primary, adjunctive, or combination psychopharmacotherapy. Avenues for future research are also discussed. Overall, results are encouraging and point to therapeutic value; however, are limited to case series and reports on anorexia nervosa. Further empirical research is thus needed to explore ketamine efficacy across ED subgroups, establish safety profiles and optimize dosing, and develop theory-driven, targeted treatment strategies at the individual patient level.
Highlights
Eating disorders (EDs) are highly prevalent, disabling, and potentially fatal psychiatric illnesses characterized by abnormal eating and weight disturbances [1,2]
16% of adults [15] are affected by EDs, with weighted population means of lifetime prevalence at 1.6% for anorexia nervosa (AN: 1.4% women, 0.2% men), 2.5% for bulimia nervosa (BN: 1.9% women, 0.6% men), 3.8% for binge eating disorder (BED: 2.8% women, 1.0% men), and 7.9% for eating disorder not otherwise specified (EDNOS: 4.3% women, 3.6% men) [16]
Ketamine may be an effective treatment alternative to electroconvulsive therapy (ECT) altogether, with reports of faster antidepressant action and improved neurocognitive performance, in attention, memory, and executive functions [123–125]. This eventually led to the approval of intranasal esketamine (Spravato® ) for treatmentresistant depression (TRD) by the Food and Drug Administration (FDA) in 2019 [126,127]
Summary
Eating disorders (EDs) are highly prevalent, disabling, and potentially fatal psychiatric illnesses characterized by abnormal eating and weight disturbances [1,2]. Given the chronic refractory nature, increased risk of premature death, and paucity of high-quality, evidence-based treatments associated with severe and enduring EDs, pragmatic shifts toward harm reduction, palliative care, and quality of life over recovery have been proposed for this subpopulation [58,89,92–96] This stems from efforts to minimize adverse impacts on sufferers, their caregivers and external support systems, and society at large [82,97]. Ketamine may be an effective treatment alternative to ECT altogether, with reports of faster antidepressant action and improved neurocognitive performance, in attention, memory, and executive functions [123–125] This eventually led to the approval of intranasal esketamine (Spravato® ) for treatmentresistant depression (TRD) by the Food and Drug Administration (FDA) in 2019 [126,127]. The interest in using ketamine in EDs originates from (1) its capacity to reduce cognitive, affective, and behavioral symptoms among psychiatric nonresponders [134,135], and (2) the pressing need to identify treatment alternatives for EDs, of which are increasingly prevalent [16], have yet to benefit from pharmacological progress [73], and remain a leading public health concern [12]
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