Will ketamine cure my eating disorder?

No. We will not claim that, and the evidence does not support it. The available research suggests ketamine may help with the depression, anxiety, and OCD that frequently travel alongside an eating disorder. Treating the eating disorder itself requires a specialized ED team that includes a therapist, dietitian, and medical clinician trained in eating disorders.

Can I do ketamine therapy if I am actively restricting?

Generally no. Ketamine has cardiovascular effects that require a stable medical baseline, including stable weight, normal electrolytes, and stable cardiac function. If you are actively restricting, purging, or medically unstable, we will not move forward until your ED team confirms it is safe. We coordinate directly with your eating disorder specialist before any session is scheduled.

What about ketamine-assisted psychotherapy in residential ED programs?

There is emerging case-series literature on group-based ketamine-assisted psychotherapy inside residential eating disorder programs. The early signal is interesting but it is not standard care, and the studies are small. Music City Ketamine is an outpatient infusion clinic, not a residential program, so this kind of intensive integrated care is outside what we offer.

Could ketamine make my eating disorder worse?

There are real theoretical risks. Dissociation during a session could be misused as a way to escape body awareness. Food intake before and after a session matters for safety and tolerability. Weight stability is a prerequisite, not an aspiration. We are honest about these risks, which is why we will not run sessions without an ED-specialized treatment team in place and engaged.

Who should I talk to first if I have an eating disorder and depression?

Start with your eating disorder treatment team: your therapist, dietitian, and the medical clinician overseeing your ED care. They are the right people to assess whether adding ketamine for comorbid depression is appropriate and safe. We join that team when invited; we do not replace it.

Ketamine and Eating Disorders: Emerging Research and the Lines We Won't Cross

What we treat and what we don't

This is the most important paragraph in the article, so we will say it plainly. Music City Ketamine does not treat eating disorders. We are an outpatient infusion clinic. We do not have a dietitian on staff, we do not run meal support, and we do not provide the medical monitoring required to manage active anorexia nervosa, bulimia nervosa, or binge eating disorder. Eating disorders are among the most medically dangerous psychiatric illnesses, and they require a coordinated team that includes an ED-specialized therapist, a registered dietitian, and a medical clinician trained to watch for cardiac, electrolyte, and refeeding risks.

What we sometimes do, in close coordination with that team, is treat the comorbid depression, anxiety, or OCD that often travels with an eating disorder. That work is off-label, the evidence is limited, and we will only proceed when an ED-specialized clinician has confirmed that the patient is medically stable enough for an infusion. If a patient does not have an ED team in place, we ask them to build one before we discuss ketamine at all. Ketamine is FDA-approved as an anesthetic; its use for any psychiatric condition, including the comorbid mood and anxiety conditions discussed here, is off-label.

Why the comorbidity matters

Eating disorders rarely arrive alone. Depression, generalized anxiety, social anxiety, post-traumatic stress, and obsessive-compulsive disorder are common traveling companions. Researchers have estimated that more than half of patients with anorexia nervosa meet criteria for major depressive disorder during their illness, and OCD overlap is substantial. The behavioral rituals, the rigid rules around food, and the intrusive body-image thoughts all share neurobiology with the wider anxiety and OCD spectrum.

For some patients, the depression that accompanies an eating disorder is the more immediately treatable problem. Mood improvement does not heal the eating disorder, but it can sometimes free up enough cognitive and emotional bandwidth for ED-specific therapy to do its work. That is the narrow lane where ketamine has shown promise, and it is the only lane we will consider entering.

Mills 1998 and the early signal

The first published case series on ketamine in eating disorders is Mills et al., 1998, in QJM (Oxford). The study described 15 patients with chronic refractory anorexia nervosa who were treated with intermittent intravenous ketamine combined with oral nalmefene, an opioid antagonist. Nine of the 15 were classified as responders. Those nine experienced prolonged remission after two to nine infusions, and their compulsion scores dropped meaningfully. Six did not respond.

This is a small study. There was no placebo arm. The patients were severely chronic and had failed multiple prior treatments, so the population is hard to generalize from. The combination with nalmefene also makes it difficult to attribute the effect cleanly to ketamine. What Mills 1998 did was open a door. It suggested that the NMDA-glutamate system, which ketamine targets, might play a role in the rigid compulsive thinking that locks patients into restrictive patterns. It did not establish ketamine as a treatment for anorexia, and 27 years later we still cannot say it does.

Schwartz 2021 and the comorbid-depression case series

A 2021 case series by Schwartz and colleagues, published in the Frontiers in Psychiatry and Clinical Case Reports literature, looked at four patients with severe enduring eating disorders and treatment-resistant depression. They received repeat intramuscular ketamine. Depression scores improved in all four cases. Effects on the eating disorder symptoms themselves, including weight, restrictive behaviors, and body-image distress, were modest and inconsistent.

Schwartz 2021 is, in our reading, the cleanest articulation of where ketamine actually fits in this population. The depression piece responded. The eating disorder piece largely did not. That is a narrow and honest finding. It points to ketamine as a tool for the comorbid mood condition in coordination with ED care, not as a tool for the ED itself. A 2021 narrative review by Keeler and colleagues in Nutrients reached a similar conclusion. The reviewers wrote that the evidence in eating disorders remains small and case-based, and that the most reasonable use of ketamine is targeting comorbid depression, anxiety, and OCD rather than ED behaviors directly.

Other emerging protocols and what to make of them

A handful of other approaches have appeared in the literature. Some residential ED programs have piloted group-based ketamine-assisted psychotherapy, with case reports describing improvements in mood and flexibility of thinking. A small number of clinicians have written about combining ketamine with ketogenic-style metabolic protocols on the theory that metabolic state affects glutamate signaling. These are early signals. They are not standard care, and the studies behind them are typically uncontrolled and small.

The American Psychiatric Association's most recent guideline on the treatment of eating disorders does not list ketamine as an evidence-based treatment, and the FDA has not approved any ketamine product for any eating disorder indication. We are watching this literature carefully. We are not extrapolating from it.

Medical safety floor and contraindications

Ketamine has predictable cardiovascular effects. It transiently raises heart rate and blood pressure during the infusion. In a medically stable patient, this is well tolerated and routine. In a patient who is actively restricting, electrolyte-deranged, bradycardic from low body weight, or in the early phase of nutritional rehabilitation, those same effects become more concerning. A heart that has been starved is not the same heart that walked into the clinic last year.

For that reason, we hold to a medical safety floor. Before we will consider an infusion in any patient with an active or recent eating disorder, we require:

An engaged ED team. A therapist with eating disorder training, a registered dietitian, and a medical clinician overseeing ED care. We need names, not just the existence of a referral.
Documented medical stability. Stable weight, normal electrolytes, stable cardiac function, and a recent EKG when clinically indicated. The ED clinician makes the call on what stable looks like.
Written coordination. A release-of-information so we can talk directly with the ED team before, during, and after the infusion series.
A clear treatment target. We are treating depression, anxiety, or OCD that the ED team has identified as a meaningful comorbid problem. We are not treating the eating disorder.
An aftercare plan that includes the ED team. Integration after a session does not happen in a vacuum. The ED therapist is the one positioned to use any cognitive flexibility or mood lift therapeutically.

If any of those pieces are missing, we will not proceed. This is not a paperwork preference; it is a clinical safety standard. Our position is that ketamine in this population without an ED team is an unacceptable risk, regardless of how much the patient or their family wants to try it.

How we coordinate with ED specialists

When an ED team refers a patient to us for comorbid treatment-resistant depression, comorbid anxiety, or comorbid OCD, the workflow is straightforward and slow on purpose. We do an initial consultation that includes a full medical history and a conversation with the referring clinician. We agree on a treatment target that is not the eating disorder. We agree on outcome measures, often the PHQ-9 for depression or the Y-BOCS for OCD, that the ED team is already tracking. We schedule the first infusion only after that coordination is in place.

During treatment, Marla Peterson, CRNA, oversees every infusion and provides anesthesia-level monitoring. A CRNA is in the room and available throughout the visit. The same monitoring standards apply that we use for any patient: continuous pulse oximetry, blood pressure, and heart rate. For patients with a history of an eating disorder, we also pay particular attention to pre-infusion intake. What to eat before and after a session is a routine clinical conversation for any patient, but it carries extra weight here. We coordinate with the patient's dietitian on a pre-session plan that meets ED-care guidance.

After each infusion, we share session notes with the ED team. If the depression scores are not moving, or if anything in the patient's eating disorder symptoms is shifting in a concerning direction, we pause. The ED team makes the call on whether to continue, modify, or stop. We do not run a maintenance schedule on autopilot.

What ketamine cannot do here

We want to be specific about the limits, because this topic invites magical thinking and we will not feed it. Ketamine cannot make someone want to eat. Ketamine cannot resolve body-image distortion. Ketamine cannot replace nutritional rehabilitation, ED-focused psychotherapy, or family-based treatment. It cannot substitute for the slow, relational work of recovery. It cannot fix a treatment team that does not exist.

Research suggests ketamine may help the comorbid depression that often sits on top of an eating disorder. That help, when it occurs, is part of a larger plan, not the plan itself. The data supports that framing; nothing larger than that is supported by the evidence. We do not invent prices and we do not invent outcomes. If cost is a question, our standard $475-per-session pricing applies; insurance does not cover off-label use.

If you are reading this with a loved one in mind, the most useful thing you can do is help them build or strengthen an ED team. Comorbid mood and attention conditions can complicate an eating disorder picture, but the foundation of recovery is the ED-specialized work. Ketamine is, at most, an adjunct to that foundation. It is never the foundation itself. For background on the broader frame of what we treat, see our pages on depression and anxiety.