Are Psychedelics the Future of Eating Disorder Treatments?

Why are eating disorders so difficult to treat?

There are several factors. Consider the fact that conditions like anorexia and bulimia are largely misunderstood and often hidden. Not to mention: We live in a culture that often celebrates calorie restriction.

And unlike with alcohol abuse disorder, when you might work to drink in moderation or stop altogether, eating disorders are “something we can’t just go ‘cold turkey’ on,” Dr. Christie said. “Recovery means shifting and healing our relationship with food, and with our bodies and body image. So it can be complicated because of this need to continue to engage in eating in order to nourish the body and stay alive,” she said.

The data paints a bleak picture of anorexia recovery. Relapse with the condition is common (think: around 30% to 40% of people relapse within 18 months). And an analysis of several studies on anorexiasuggests that of people with anorexia who died, one in five died by suicide. As for other eating disorders: Studies show they’re also deadly, potentially even “similar” to anorexia’s mortality rates.

What are some options for eating disorder treatment now?

Dr. Christie said that standard treatment can involve pharmaceuticals (like using antidepressants, particularly for bulimia and binge-eating disorders) and psychotherapy (think: cognitive behavioral therapy). There’s also the option of private inpatient and outpatient treatment for ED recovery, but only if you have the willingness to go and the resources (treatment can be costly). 

People who are extremely low-weight and medically unstable might get admitted to hospital re-feeding programs. But Dr. Christie said that many leave before completing the program. Because many people dealing with eating disorders can be “legitimately afraid of food and eating,” she said. “And it can actually feel quite traumatic to be forced into consuming foods.” 

What could psychedelic-assisted eating disorder therapy look like?

Well, it wouldn’t be like partying at a rave. But the general structure would likely look like this: You meet with specialists to prepare for the session, set up an appointment, and on the day of, go into a specialized room — likely with a professional supervising — for your psychedelic session. You’ll probably schedule a specific number of sessions over the course of a few weeks. Session details could vary depending on your clinic and the kind of therapy. For example: there’s a good chance you’ll listen to specific music while you take the psychedelic, you could use eye-shades as the drug kicks in, and you might have an “integration” session with a therapist after the psychedelic experience. As for how the experience differs by drug, Dr. Christie helped us break that down.

Psychedelics that could be used to treat eating disorders include:

Psilocybin (aka magic mushrooms)

Research shows that…psilocybin could be an effective treatment for depression. And it also has potential to help with end-of-life anxiety and eating disorders, Dr. Christie said. Of note: A 1959 study conducted in Paris is widely considered the first known demonstration of the safety and efficacy of psilocybin for treating someone with anorexia. It included a 35-year-old woman who was given two psilocybin injections (though capsules are typically used in research these days), four days apart. And that led to immediate and lasting improvements in mood and wellbeing. Today, the Imperial College of London is sponsoring more studies on psilocybin and eating disorders. And just FYI, according to Dr. Christie, a psilocybin session might take about six hours and involve two therapists.

It works by…increasing the number of neural connections in the brain (which can create new potential for insight and openness) and disconnecting some of the hardwired connections (that can contribute to ruminating thought patterns often involved in eating disorders and depression). 

And Dr. Christie said that psilocybin has the potential to offer something that her experience with ayahuasca, another classic psychedelic, did: insight into the root cause of why an ED developed in the first place. In Dr. Christie’s case, that meant info on why she spent years of her young adult life cycling between food restriction, and binging and purging. It helped her consider the ways she felt she wasn’t supported in her childhood, and how developing an eating disorder was a “coping strategy to deal with tremendous relational stress and strain.” 

A drug like psilocybin might also allow for “different sensory things” (think: visual and auditory hallucinations). And could lead to “deeply spiritual and meaningful experiences,” Dr. Christie said. In her case, that meant better understanding the “layers of shame” she had gone through, and then experiencing “deep layers of healing.” 

It could be available in…two to three years for off-label use in treating eating disorders, Dr. Christie estimates. But that’ll depend on where you live. Federally, it’s still a schedule I substance under the Controlled Substances Act. Meaning it has a high potential for abuse and, currently, there’s no accepted medical use for it. But times are changing. The FDA granted the substance breakthrough therapy status in 2018 and 2019 for treatment-resistant depression and major depressive disorder, which means that the process of developing and reviewing it should go quicker than usual. And there are now a number of US cities (in states like California, Colorado, etc) that have already decriminalized this kind of psychedelic, or are looking to do it soon. However, psilocybin “is certainly not in mainstream medical practice yet,” Dr. Christie said.

MDMA (aka Ecstasy or Molly)

Research shows that…MDMA paired with talk therapy can lessen and alleviate PTSD symptoms. And there are studies in the works on MDMA-assisted therapy for anorexia, bulimia, and binge-eating disorders. After the success of the PTSD study, “We’re at the stage now of looking at MDMA for other indications,” Dr. Christie said. Here’s how that MDMA study published in Nature Medicine worked: participants had three prep sessions with two trained therapists. Followed by three eight-hour sessions — each spaced a month apart — where they received therapy coupled with a placebo or MDMA dose. The results: Two months after treatment, 67% of participants who took MDMA no longer qualified for a PTSD diagnosis, compared to 32% of the placebo group. The FDA granted MDMA-assisted psychotherapy the breakthrough therapy designation for treatment of PTSD in 2017. 

It works by…reducing activity in the amygdala, the part of the brain that Dr. Christie calls the “smoke detector for threat.” Suppressing that can help manage trauma and fear, and MDMA can also open you up to being more empathetic, extroverted, and sociable. Empathy for others is important for someone with an ED, because “isolation is such a factor in mental illness,” Dr. Christie said. And empathy for yourself is also a big deal for someone in ED recovery, because cultivating self-compassion can help you understand your experience and be kind to yourself. And just so you know, unlike other psychedelics, MDMA doesn’t tend to cause extreme hallucinations or a “loss of ego effect,” Dr. Christie said. 

It could be available in… possibly the next two years for PTSD, Dr. Christie said. Because there’s a good chance it’ll be quickly approved after the MDMA/PTSD study is completed. (It’s currently in Phase 3 clinical trials.) And when it comes to using the drug off-label for eating disorders, “it’s a matter of how flexible regulatory bodies are,” Dr. Christie said. Because MDMA is also a schedule I drug. “But there's definitely movement happening with MDMA for eating disorders.”

Ketamine (aka Special K)

Research shows that…ketamine — which has long been accepted for medical use as a general anesthetic — has promise as an effective treatment for eating disorders. In a recent case report, a 21-year-old, who was binge-eating and vomiting 40 times a day, underwent three courses of ketamine-assisted therapy over three months, with each course consisting of six sessions scheduled twice weekly. She showed huge reductions in binging and purging after the first treatment, and by the third month stopped altogether. The remission lasted at least a year. Thing to know: In 2019, the FDA approved a nasal spray made with a derivative of the ketamine molecule for treatment-resistant depression. But a 2020 comparative study suggests that ketamine taken intravenously could be more effective for depression than the nose spray. 

It works by…inhibiting NMDA receptors, which are thought to be involved in cognition. In other words, ketamine can interfere with your learning and memory. When used before surgery as an anesthetic, ketamine puts you out, and you may not remember anything once you come to. But the doses for mental health treatment are generally much lower. So you stay awake, but can disassociate from your body. It’s “trance-like,” Dr. Christie said. “There’s a sense of ‘I may not feel my body as much, but I know who I am.'”

And you could get to the point where you feel “floaty” and the pain you were carrying from depression or an eating disorder “loosens,” she added. FYI: Dr. Christie says intravenous ketamine comes on faster than some of the other psychedelics, with therapy sessions only two to three hours long. And while data shows that ketamine can help reversedepression symptoms quickly, that effect could drop off after about a week, Dr. Christie said. That’s why she thinks it’s important for ketamine therapy to include both the medicine session and an integration session, where you talk to a therapist about how you feel and commit to actions aligned with your values, she said. This can really “help the therapeutic change stick in your life.”

It could be available in…your city right now, as a treatment for depression. And possibly off-label for eating disorders in the next year or two. There are currently ketamine clinics nationwide that administer the drug through the veins or a muscle, or as a lozenge or nose spray. Psychotherapy may or may not be part of your visit. And there are some businesses that enable you to take ketamine from home. If you’re interested in a ketamine clinic, do your research. For starters, you could see if a local clinic is listed in the directory of the American Society of Ketamine Physicians, Psychotherapists and Practitioners, which has specific standards and ethical codes for being a member. And Dr. Christie recommended seeking places with trauma-informed care. 

EXPERT INTERVIEWED Dr. Devon Christie