Eating disorders – including anorexia nervosa, bulimia nervosa, and binge‑eating disorder – affect about 28 million people in the US and have the highest mortality rate of any psychiatric condition.
Standard care typically combines psychotherapy, nutritional support, and antidepressants, yet relapse rates remain high and fewer than one in four patients achieve full remission with conventional therapy.
Given these limitations, researchers are examining whether ketamine – an anesthetic that blocks N‑methyl‑D‑aspartate (NMDA) receptors – could help patients stuck in cycles of compulsive eating, purging, or restriction.
This article reviews preliminary evidence for ketamine in eating disorders, explains how it may act on the brain, and discusses ethical considerations and next steps.
In This Article
- Understanding the need for new approaches
- Preliminary evidence for anorexia nervosa
- Emerging evidence for bulimia nervosa and binge‑eating disorder
- How ketamine may help: neuroplasticity and compulsive behaviour
- Risks, limitations, and ethical considerations
- Choosing a provider and integrating treatment
- Resources and future directions
- A path toward healing: What to expect?
- Ready to embrace a new path?
Understanding the need for new approaches
An eating disorder arises from a persistent disturbance in eating behaviour and distressing thoughts and emotions.
It often begins with an unhealthy body image and a desire to fit into certain social standards, but genetic vulnerabilities, trauma, and psychiatric comorbidities such as anxiety, depression, and obsessive–compulsive disorder (OCD) also play a role.
The chronic cycle of bingeing, purging, or severe restriction alters the brain’s reward circuitry and reinforces compulsive patterns.
Standard therapies such as cognitive‑behavioural therapy (CBT), selective serotonin reuptake inhibitors (SSRIs), and family‑based therapy help many people, yet remission rates remain disappointingly low. Relapses are common, and symptoms often resurface when stressors arise.
Ketamine’s antidepressant and anti‑anxiety effects at low doses have been well documented in treatment‑resistant depression. Its rapid action – within hours – is attributed to modulation of glutamate pathways and increased neuroplasticity.
Because eating disorders share underlying mechanisms such as compulsive thoughts, rigid cognitive patterns, and co‑occurring mood symptoms, ketamine has emerged as a promising avenue for individuals who have not responded to conventional care.
However, research remains in its infancy, and the evidence comes primarily from small case reports and pilot studies.
Preliminary evidence for anorexia nervosa
Case reports and case series
The most detailed case study to date combines a ketogenic diet with intravenous (IV) ketamine. A 15‑year-old girl who had struggled with extreme anorexia nervosa for over 13 years received a ketogenic diet followed by IV ketamine infusions.
The initial dose was 0.75 mg/kg, and it was titrated up to 1.2 mg/kg over several sessions. She experienced transient side effects such as nausea and dissociation during infusions, but within weeks her mood improved dramatically, and obsessive thoughts about calories and body image decreased.
Remarkably, she maintained full remission and a healthy body weight for more than six months. The authors attribute this success to ketamine’s ability to enhance neuroplasticity and disrupt entrenched fear circuits.
While encouraging, this is an isolated case; ketogenic diets and ketamine both affect metabolism, so the synergy may not generalize to all patients.
Earlier reports from the 1990s describe 15 individuals with chronic anorexia nervosa who were given two to 15 ketamine infusions combined with nalmefene, an opioid antagonist.
Nine patients achieved remission; another four showed partial improvement. These early results, though uncontrolled, suggest that repeated ketamine dosing may help reset compulsive restricting patterns.
More recent case series of intramuscular ketamine‑assisted psychotherapy (KAP) similarly report clinically significant improvements in depressive symptoms and anxiety in four out of five participants and reductions in eating‑disorder symptoms for some.
Adverse effects were mild and included dissociation and temporary increases in blood pressure, supporting the safety of supervised dosing.
Animal models and mechanistic insights
Animal research offers further clues. In rodent models of activity‑based anorexia, where rats combine food restriction with excessive exercise, ketamine injections reduced self‑starvation and hyperactivity.
Researchers observed increased levels of brain‑derived neurotrophic factor (BDNF) and improved synaptic plasticity in the hippocampus and prefrontal cortex – areas involved in reward and decision‑making.
These findings suggest that ketamine may recalibrate circuits that mediate compulsive behaviors, fear conditioning, and negative body image.
Such neurobiological effects could help explain the rapid mood improvements seen in human case reports and underscore why ketamine is being explored in other compulsive disorders such as OCD and substance use.
Emerging evidence for bulimia nervosa and binge‑eating disorder
Although most research has focused on anorexia, early data hint that ketamine could also benefit bulimia and binge‑eating disorder.
A case report described a 21‑year-old woman with extreme bulimia nervosa who underwent three courses of ketamine‑assisted psychotherapy over three months, with six sessions per course.
Following treatment, her bingeing and purging ceased completely, and she maintained remission for over a year.
The clinicians emphasised that KAP allowed her to access underlying traumas and develop self‑compassion, supporting the idea that ketamine experiences combined with therapy can unlock entrenched patterns.
Another small case series known as G‑KAP used intramuscular ketamine alongside psychotherapy in five patients with various eating disorders.
Participants completed three phases of KAP; two of the five achieved clinically significant reductions in eating‑disorder symptoms, and four experienced marked decreases in depression and anxiety.
The authors note that patients appreciated the rapid mood shifts and newfound cognitive flexibility, which facilitated healthier eating patterns.
However, because these studies lacked control groups and sample sizes were tiny, more rigorous trials are essential.
How ketamine may help: neuroplasticity and compulsive behaviour
Ketamine is primarily an NMDA receptor antagonist. At subanesthetic doses, it increases glutamate release, leading to activation of α‑amino‑3‑hydroxy‑5‑methyl‑4‑isoxazolepropionic acid (AMPA) receptors and subsequent release of brain‑derived neurotrophic factor (BDNF).
BDNF promotes synaptogenesis and dendritic spine growth, thereby enhancing neuroplasticity. In individuals with eating disorders, this increased plasticity may facilitate new learning and flexible thinking, allowing patients to disengage from rigid beliefs about weight and control and to adopt healthier behaviours.
Functional brain imaging studies in depression show that ketamine increases connectivity in the prefrontal cortex and limbic regions; similar changes might reduce overactive reward circuits tied to bingeing and purging.
Ketamine’s antidepressant and anti‑anxiety properties also play a role. Many patients with eating disorders suffer from comorbid depression, anxiety, or PTSD, which can perpetuate disordered eating.
By rapidly improving mood and decreasing anxious rumination, ketamine may create a window in which patients are more receptive to therapy and nutritional rehabilitation.
In addition, ketamine experiences often produce mystical or out‑of‑body sensations that some patients describe as moments of self‑compassion or connection; when integrated with psychotherapy, these experiences may help them challenge critical inner voices and develop healthier relationships with their bodies.
Risks, limitations, and ethical considerations
Despite encouraging early results, ketamine is not a first‑line treatment for eating disorders, and significant ethical questions remain. Patients with eating disorders often have medical instability, including malnutrition, electrolyte imbalances, and cardiac abnormalities.
Ketamine can cause nausea, dizziness, dissociation, and transient increases in blood pressure. For underweight or medically fragile individuals, these side effects may pose additional risks.
Clinics must therefore conduct thorough medical assessments and work closely with primary care physicians, psychiatrists, and nutritionists to determine whether ketamine is appropriate.
The evidence base is also limited. Most reports involve single individuals or small series without control groups.
Dosage regimens vary widely (0.5 mg/kg to 1.2 mg/kg), and the optimal number of sessions remains unclear. The synergy observed in some reports between ketamine and a ketogenic diet, or between ketamine and psychotherapy, might not apply to all patients.
More research is needed to understand which subtypes of eating disorders respond best, how long benefits last, and whether repeated treatments carry cumulative risks.
Larger, randomized controlled trials will help answer these questions and determine whether ketamine should be integrated into standard care.
Another ethical issue involves the risk of misuse. Ketamine has psychoactive properties and a history of recreational use; unsupervised self‑administration can lead to cognitive problems, urinary tract issues, and addiction.
Any ketamine therapy should be offered in a medical setting with appropriate monitoring and integration support. Patients should be informed that ketamine is currently an off‑label treatment for eating disorders and that existing evidence is preliminary.
Choosing a provider and integrating treatment
If you are considering ketamine therapy for an eating disorder, it is essential to choose a qualified provider. Look for clinics staffed by licensed physicians and mental‑health professionals with experience in both psychedelic medicine and eating disorders.
Reputable clinics offer a thorough intake evaluation, discuss medical history and current medications, and tailor dosing schedules to the individual.
They should provide integration sessions to help patients process their experiences and apply insights to daily life. The environment should feel safe and supportive; avoid clinics that promise cures or advertise ketamine as a standalone solution.
During treatment, patients may benefit from combining ketamine with psychotherapy, nutritional counselling, and other evidence‑based interventions.
For example, ketamine experiences might open the door to cognitive restructuring, but long‑term recovery still requires developing healthy coping skills and addressing underlying trauma or emotional pain.
Peer support groups and family involvement can reinforce progress and provide accountability.
Resources and future directions
- National Eating Disorders Association (NEDA): Offers crisis support, educational resources, and directories for specialized treatment.
- Clinical trials: New studies are underway, including a University of California, San Francisco trial examining IV ketamine for anorexia nervosa. Patients may wish to inquire about participating in research through academic medical centers.
- Daytryp’s Eating Disorder Program: Our team combines psychedelic therapies with integrative care to support individuals struggling with eating disorders.
A path toward healing: What to expect
Ketamine is not a magic bullet, but for some individuals with treatment‑resistant eating disorders, it may open new pathways toward recovery.
After an initial medical evaluation, patients typically receive a series of low‑dose infusions or intramuscular injections under medical supervision.
Sessions last about 45–60 minutes, during which clinicians monitor vital signs. Patients often experience a dream‑like state and may gain new perspectives on entrenched thought patterns.
Follow‑up therapy sessions help translate these insights into healthier eating behaviours and self‑care routines. Adherence to nutritional guidelines and continuous mental‑health support remain vital for sustained recovery.
While the research is promising, we must approach ketamine therapy for eating disorders cautiously. The field is still evolving, and large‑scale studies will determine its long‑term safety and efficacy.
As we explore this new frontier, collaboration between researchers, clinicians, patients, and advocates will be essential to ensure that treatment advances are both ethical and effective.
Ready to embrace a new path?
Unlock Hope and Healing
If you or a loved one is battling an eating disorder and feels stuck with traditional treatments, ketamine therapy might offer a new perspective.
At Daytryp Health, our compassionate team specializes in psychedelic‑assisted therapies that promote lasting change.
We combine medical expertise, psychotherapy, and integration coaching to create a safe, supportive environment for your healing journey.
Contact us today to schedule a consultation and learn whether ketamine therapy is right for you.
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