Ketamine treatment in 2025: Revolutionary hope for eating disorders or too soon to tell?

As we welcome the New Year—a time of renewal, hope, and new beginnings—I find myself reflecting on the possibilities that lie ahead for those affected by eating disorders. The turning of the calendar isn’t just about a change in date; it’s an opportunity to embrace new horizons in healing and recovery.  

In the spirit of fresh starts and optimism, I want to introduce you to an emerging treatment option that may offer renewed hope for those who have struggled for too long: ketamine and esketamine treatment

Over the years, I’ve witnessed the profound challenges that long-standing eating disorders and treatment-resistant depression present. For some individuals and their families, traditional treatments haven’t provided the relief we all hope for. It’s understandable to feel disheartened when therapies that work for others don’t seem to help you or your loved one.  

Before I go any further, I want to recognise that the mention of ketamine treatment might immediately raise your concerns, especially regarding its potential for misuse and abuse. You might be wondering about the safety and appropriateness of using such a substance in treatment, particularly for young adults. I want to assure you that these concerns are valid. I will be addressing them as we explore this topic together.  

Understanding Ketamine and Esketamine Treatment 

Ketamine, originally used as an anaesthetic and still favoured in some cases due to its safety in severely unwell patients, has been found to have fast-acting antidepressant properties at repeated lower doses. Esketamine, a derivative of ketamine developed specifically for treating depression, is given as a nasal spray. Both have shown promise in helping individuals who haven’t responded to traditional treatments. 

In clinical practice: 

  • Ketamine is generally administered intravenously in a controlled environment, such as a hospital, under medical supervision. Each session typically lasts about 40 minutes to an hour, with patients monitored closely throughout administration and recovery. It is also available orally, although this is less commonly prescribed. 
  • Esketamine is given as a nasal spray in a healthcare provider’s office or clinic. After administration, patients are observed to ensure their safety and that they have fully recovered. 

 

Why Consider These Treatments? 

For those battling with long-standing eating disorders and treatment-resistant depression, ketamine and esketamine both offer potential benefits that are hard to ignore: 

  • Rapid symptom relief: They can produce quick improvements, sometimes within hours, breaking the cycle of negative thought patterns. The benefits often become more pronounced as treatment continues. 
  • Enhanced neuroplasticity: By promoting the growth of new neural connections, in successful cases they help the brain adopt healthier thought patterns and behaviours. 
  • Increased engagement in therapy: Individuals often become more receptive to psychotherapy, enhancing overall treatment outcomes. 

 

Concerns About Ketamine Use and Abuse 

I understand that the idea of ketamine treatment might cause you some concern, especially given its association with recreational misuse among young people in the UK and recent high-profile reports of serious harm from high doses and frequent use.  

As a parent or family member, you might be asking: Why would we even consider a substance that’s often misused? It’s crucial to distinguish between the controlled, therapeutic use of ketamine in a medical setting and its unregulated, recreational use. 

In a responsible medical context, ketamine is: 

  • Administered by professionals: Given by trained healthcare providers who monitor patients before, during, and after treatment. 
  • Precisely dosed: Delivered in controlled, low doses tailored to therapeutic needs. 
  • Used in a safe environment: Conducted in clinical settings equipped to handle any adverse reactions. 
  • Purposeful in its use: Intended to alleviate severe symptoms and improve quality of life and stopped in case of side effects or adverse events. 

In contrast, recreational misuse involves: 

  • Unregulated dosages: Unknown purity and quantity, increasing the risk of overdose, often caused by another substance, such as an opioid, ingested by mistake. 
  • Unsafe environments: Taken with a lack of medical supervision and support. 
  • Legal risks: Possession and use outside medical guidelines can have serious legal consequences.  
  • Health dangers: Potential for addiction, cognitive impairment, and physical harm. The dosages taken in misuse are typically over ten times the therapeutic dose, which explains why the side effects seen in recreational misuse are not common under controlled, medically supervised conditions. While clinical use at low, carefully monitored doses significantly reduces these risks, it doesn’t eliminate them entirely – so ongoing assessment and safety measures remain vital.  

By understanding these differences, we can appreciate how ketamine, when used responsibly in a medical setting, can offer significant benefits while minimising risks. 

Frequently Asked Questions about ketamine treatment  

Knowledge is power. Clinicians suggesting treatment using ketamine or esketamine often get asked questions about the experience. I’ve recreated and answered the questions, to give you as much information as possible.  

“I’m scared and anxious about trying ketamine treatment. How will it affect me or my loved one?” 

It’s completely natural to feel apprehensive about trying something new, especially when it involves substances like ketamine or esketamine. During ketamine infusions, some people experience mild sensations such as light-headedness or a dream-like state. These effects typically subside shortly after the session ends. With esketamine nasal spray, temporary changes in perception or feelings of dissociation may occur, but these are closely monitored by healthcare professionals and usually resolve within a couple of hours. 

Medical teams are there to support patients throughout the process, providing reassurance and managing any side effects. Before starting treatment, a comprehensive assessment is carried out to determine whether this therapy is appropriate, considering each patient’s medical history and current condition. 

“What are the side effects?” 

Side effects can include nausea, mild increases in blood pressure, or dizziness. These are generally short-lived and manageable. Healthcare professionals are prepared to help with these symptoms effectively, ensuring the patient’s safety and comfort at all times. 

“How severe does my condition need to be to consider this treatment?” 

Ketamine and esketamine therapies are typically considered for those who have not responded to traditional treatments such as psychotherapy and standard antidepressant medications. A thorough evaluation will help to determine if this approach is suitable for you or your loved one. 

“As a parent or family member, why would I support a treatment involving substances we tell our young adults to avoid?” 

This is a valid concern. The key difference lies in the context and intent. In a responsible medical setting: 

  • Controlled use: Treatments are administered legally, safely, and with professional oversight. 
  • Therapeutic intent: The goal is to heal and improve quality of life, not to induce recreational effects. 
  • Safety protocols: Strict guidelines and monitoring are in place to protect patients. 

 

The Science Behind the Treatment 

Ketamine and esketamine work by interacting with NMDA receptors, which are a specific type of receptor for glutamate, the most abundant excitatory neurotransmitter (signal molecule) in the brain. By blocking these NMDA receptors, ketamine leads to an increase in glutamate signalling through other pathways, promoting synaptic plasticity—the brain’s ability to form new neural connections. 

This process may help the brain adapt, potentially supporting the development of healthier thought patterns. By enhancing communication between different brain regions—a phenomenon sometimes referred to as network “desegregation”—these treatments could increase cognitive flexibility and disrupt negative thought loops common in depression and eating disorders. 

Many mental health conditions, including depression and eating disorders, have been linked to overactivity in specific brain networks like the Default Mode Network (DMN). The DMN is a network of interacting brain regions that is active when the mind is at rest and engaged in self-referential thoughts or daydreaming.  

Some research suggests that overactivity in the DMN may contribute to entrenched patterns of negative thinking and rumination. By potentially reducing this overactivity, ketamine and esketamine could help individuals loosen these patterns, fostering new perspectives and coping strategies. 

 

Guidelines and Accessing Ketamine Treatment in the UK 

Ketamine has been used as a general anaesthetic during operations and to help with severe pain for many years. Over time, and especially in the last 20 years, its use as a fast-acting antidepressant has been explored, and esketamine was developed specifically to be used as an antidepressant. 

While ketamine and esketamine therapies are not yet widely available in all healthcare settings, their availability has improved in the UK, both for clinical trials and in practice. 

  • Intravenous and oral ketamine are currently available in the UK but prescribed ‘off label’ because specific studies exploring optimal dose and efficacy are still needed. 
  • In some NHS hospitals, ketamine is being administered under the supervision of psychiatrists for patients with severe depression and eating disorders who are hospitalised. This usage is typically within the context of closely monitored treatment plans, where patients can be observed for effectiveness and side effects. 
  • Clinical trials for intravenous and oral ketamine are ongoing for the treatment of alcohol misuse and treatment-resistant depression. For example, the EDEN project at King’s College London has recently been awarded £1.45 million for a clinical trial specifically looking at ketamine for anorexia nervosa and treatment-resistant depression. 
  • Esketamine nasal spray is currently licensed in the UK for treatment-resistant depression. While it’s not currently recommended by NICE due to cost reasons, it is available privately and in some NHS settings. 

This emerging practice reflects a growing recognition of ketamine’s potential benefits and a willingness within the medical community to explore new treatment avenues for those who have not responded to traditional treatments. 

 

Considerations, Safety, and Ethical Concerns 

Before embarking on ketamine or esketamine treatment, it’s crucial to understand the broader context in which these treatments are delivered. While they represent promising new frontiers in treating severe and treatment-resistant conditions, we must remember that they remain emerging therapies. Larger, long-term clinical trials are still needed to fully establish their safety, efficacy, and optimal dosing. As a result, these interventions may not be suitable for everyone, and careful medical assessment is crucial before beginning treatment. 

Consultation and eligibility:

If you’re interested in exploring ketamine treatment, discuss it with your psychiatrist or medical team. They can provide guidance based on the most current evidence and help determine if this treatment is suitable. Access often depends on factors like the severity of the condition, previous treatment history, and overall health status. Ketamine and esketamine are generally considered for adults with treatment-resistant conditions. 

Monitoring and safety:

It’s vital that ketamine or esketamine treatment be administered and supervised by qualified healthcare professionals who can ensure patient safety, monitor responses, and adjust dosages as needed. Treatments provided in inpatient wards or controlled clinical settings allow for continuous monitoring, ensuring immediate support if any side effects occur. 

Symptomatic relief vs. long-term cure:

It’s also important to recognise that these therapies often provide symptomatic relief rather than a lasting cure. While symptoms may improve relatively quickly, there’s a risk of rapid relapse if treatment is stopped suddenly—especially within the first 6–12 months. This often means a longer-term commitment to maintain benefits. If the treatment is NHS-funded, cost may not be a major issue. However, for those accessing care privately, the ongoing financial burden can become significant. 

That said, these treatments can also serve as a bridge to deeper, long-term recovery. By alleviating symptoms and improving cognitive flexibility, ketamine and esketamine may help individuals to reach a state where they’re more able to engage in talk therapy, make lifestyle changes, and benefit from social support networks. This combination of symptom relief and ongoing psychological or social interventions may ultimately reduce their risk of relapse and promote a more sustainable recovery. 

Ethical and financial considerations:

Unfortunately, there have been reports of some private clinics starting treatment, promising ongoing support, and then withdrawing follow-up once patients depend on the therapy to manage their symptoms. This can leave individuals facing a return of severe symptoms, along with stress, ethical dilemmas, and financial strain. Before beginning these treatments, you should thoroughly research the providers, clarify their follow-up protocols, and consider the long-term affordability to ensure continuity of care if the therapy proves beneficial. 

Looking ahead to the future 

While ketamine and esketamine are available now, research is ongoing into other alternative therapies, such as psilocybin—the active compound found in certain mushrooms. Currently, psilocybin is a controlled substance in the UK and not legal for medical use outside of clinical trials. However, studies are exploring its potential benefits for various mental health conditions, including depression and eating disorders. If evidence continues to support its efficacy and safety, psilocybin may become a treatment option in the future. 

Final thoughts 

As we step into the New Year, it’s a time for renewal, learning, and exploring possibilities. I hope this information helps broaden your understanding of some emerging treatments. Empowering yourself with knowledge, asking questions, and seeking professional guidance will support you in making informed decisions that align with your individual circumstances and values. 

 

Resources for further exploration 

 
Take care,
Courtney 

 

Disclaimer
I am a healthcare professional but not a psychiatrist. This information is intended to open a conversation and share what I know about emerging treatments. While I have fact-checked this content with a psychiatrist, it should not replace professional medical advice. Please consult with your psychiatrist or other qualified medical provider before making decisions about your treatment options. 

Share this article

Download our Body Image Worksheet today

Work through our guided steps, and improve your relationship with your body. Enter your details to receive it straight away!

Thank you for requesting our Body Image Worksheet. It is winging its way to you now, so please check your email inbox (and spam folder) to make sure you receive it!