Severe and enduring eating disorders carry the highest mortality rate of all psychiatric illnesses, especially when combined with treatment-resistant depression. Four patients with both conditions received repeated ketamine treatments over 12 or more months. Depression improved, but eating disorder symptoms changed only modestly.
Anorexia nervosa has one of the highest mortality rates among mental illnesses, yet no approved pharmacological treatments exist. This narrative review examines traditional pharmacotherapy and novel treatments—including dissociative anesthetics, psychedelics, cannabinoids, hormones, neurosteroids, and ketogenic nutrition—for altering neurobiology and behavior. The authors recommend a neuroscience-based medication approach targeting dopamine receptors to enhance cognitive flexibility and reduce food-related dread when psychotherapy fails. Treating comorbid anxiety, depression, and obsessive-compulsive disorder is essential, as these conditions persist even after successful anorexia treatment. Novel strategies show promise for improving mood and reducing specific anorexia psychopathology and may soon enter clinical practice.