Policy suggested:
“Adopt the ketogenic diet as an intervention patients/families can choose for psychiatric treatments. This should especially be considered for when patients dont respond well to medication, when patients get side effects from medication or when patients would prefer solutions different than medication. It may also be used together with medication in cases where that seems necessary and the patients want it.”
“The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of 31 Inpatients
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Study design: In this retrospective analysis of clinical care, 31 adults with severe, persistent mental illness (major depressive disorder, bipolar disorder, and schizoaffective disorder) whose symptoms were poorly controlled despite intensive psychiatric management were admitted to a psychiatric hospital and placed on a ketogenic diet restricted to a maximum of 20 grams of carbohydrate per day as an adjunct to conventional inpatient care. The duration of the intervention ranged from 6 to 248 days.
Study results: Three patients were unable to adhere to the diet for >14 days and were excluded from the final analysis. Among included participants, means and standard deviations (SDs) improved for the Hamilton Depression Rating Scale scores from 25.4 (6.3) to 7.7 (4.2), P < 0.001 and the Montgomery-Åsberg Depression Rating Scale from 29.6 (7.8) to 10.1 (6.5), P < 0.001. Among the 10 patients with schizoaffective illness, mean (SD) of the Positive and Negative Syndrome Scale (PANSS) scores improved from 91.4 (15.3) to 49.3 (6.9), P < 0.001. Significant improvements were also observed in metabolic health measures including weight, blood pressure, blood glucose, and triglycerides.
Conclusions: The administration of a ketogenic diet in this semi-controlled setting to patients with treatment-refractory mental illness was feasible, well-tolerated, and associated with significant and substantial improvements in depression and psychosis symptoms and multiple markers of metabolic health.”
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“Dr. Danan, the first author, has been a practicing psychiatrist in Toulouse, France for 35 years.”
Georgia Ede, one of the other authors, is a Harvard educated psychiatrist and has many years of experience too: About Dr. Ede - Diagnosis Diet
“I am a Harvard-trained, board-certified psychiatrist specializing in nutritional and metabolic psychiatry. My passion is empowering people with psychiatric conditions to reduce or eliminate the need for medications by changing how they eat. But which changes are worth making, and why? Answering that question is what my work is all about”
KD = ketogenic diet.
“Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial
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The ketogenic diet (KD, also known as metabolic therapy) has been successful in the treatment of obesity, type 2 diabetes, and epilepsy. More recently, this treatment has shown promise in the treatment of psychiatric illness. We conducted a 4–month pilot study to investigate the effects of a KD on individuals with schizophrenia or bipolar disorder with existing metabolic abnormalities. Twenty–three participants were enrolled in a single–arm trial. Results showcased improvements in metabolic health, with no participants meeting metabolic syndrome criteria by study conclusion. Adherent individuals experienced significant reduction in weight (12 %), BMI (12 %), waist circumference (13 %), and visceral adipose tissue (36 %). Observed biomarker enhancements in this population include a 27 % decrease in HOMA–IR, and a 25 % drop in triglyceride levels. In psychiatric measurements, participants with schizophrenia showed a 32 % reduction in Brief Psychiatric Rating Scale scores. Overall Clinical Global Impression (CGI) severity improved by an average of 31 %, and the proportion of participants that started with elevated symptomatology improved at least 1–point on CGI (79 %). Psychiatric outcomes across the cohort encompassed increased life satisfaction (17 %) and enhanced sleep quality (19 %). This pilot trial underscores the potential advantages of adjunctive ketogenic dietary treatment in individuals grappling with serious mental illness.”
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Quotes from patients in the study:
"“Since being on the diet, I haven’t noticed any significant anxiety level or attacks. And I’ve been able to work through basically everything I’ve come across.”
"It can honestly save a lot of lives, it saved mine. I would not be here today if it wasn’t for Keto. It’s helped a lot with my mood Stabilization.”
“[…] if things continue in a positive trajectory, it’s definitely not out of the real[m] of possibility that my bipolar could go into remission.”
“My opportunity to participate in the metabolic psychiatry study transformed my life. I gained knowledge, became able bodied again and my mood disorder and eating disorder symptoms lessened dramatically. I became sexually active again after 16 years of celibacy.”
“I can tell you that I have never felt better than I have since using ketosis, it worked far better than the lamotrigine ever did.”"
Study 3: The Ketogenic Diet as a Treatment for Mood Disorders | Current Treatment Options in Psychiatry
The Ketogenic Diet as a Treatment for Mood Disorders
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Case Reports and Case Series
As detailed in a case study, a 65-year-old female diagnosed T2DM and major depressive disorder engaged in a 12-week ketogenic diet regimen [72]. Following the intervention, notable improvements were evident across both physiological and psychological realms. Alongside reductions in HbA1C and blood glucose levels, the patient reported amelioration of depressive symptoms and enhanced adherence to diabetes management. Notably, after the 12-week period, medication usage decreased by 75%. Moreover, the patient experienced heightened self-assurance, increased self-efficacy, elevated energy levels, enhanced sleep quality, and greater bodily stability [72].
In another case report, a 21-year-old female with obesity, a mood disorder, and comorbid conditions including emotion dysregulation, body dysmorphic disorder, and an eating disorder, underwent a 4-week ketogenic diet. Following the 4-week dietary regimen, notable improvements were observed, including stabilized mood, decreased anxiety, and normalization of the circadian rhythm. Additionally, the patient reported the absence of suicidal thoughts, alongside recorded weight loss [73].
The Ketogenic Diet as a Transdiagnostic Treatment for Neuropsychiatric Disorders: Mechanisms and Clinical Outcomes
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Discussion
The ketogenic diet appears to be a transdiagnostic treatment that targets shared pathophysiological mechanisms underlying various neuropsychiatric disorders. While the preliminary findings are promising, some studies, and especially the case reports, consist of small samples. Larger randomized controlled trials are crucial to conclusively confirm the therapeutic potential of this diet and elucidate its mechanisms of action across diverse populations. Nonetheless, the present review summarizes the effects of the diet on 1,906 individuals, providing evidence that the diet is safe, feasible, and efficacious in ameliorating measurable symptoms of psychopathology. Although the ketogenic diet has been trialed more for some diagnoses than others, its efficacy across the myriad of disorders in this review is intriguing. As a medication-free treatment option, it could lower the disease burden of psychiatric disorders in many ways. First, if the cost of medication/lack of insurance is a barrier to treatment, adapting one’s diet to optimize mental health may be a more accessible alternative for some. Further, psychotropic medications, particularly antipsychotics, are known to have a variety of side effects affecting almost every system of the body. Evidence suggests that the ketogenic diet may be more tolerable than medication, as its side effects are mild and typically resolve during the first weeks of treatment. Moreover, it may also enhance physical/metabolic health (by reducing reductive stress and inflammation, among others), potentially producing additional improvements in quality of life. Finally, the studies and case reports describe striking symptom reduction in some of the most debilitating, treatment-resistant disorders (e.g., schizophrenia), suggesting that this treatment may be a crucial intervention for those who do not respond to medication and other evidence-based therapies.
Study 5: https://academic.oup.com/ijnp/article/23/7/434/5861311?login=false
Ketogenic Therapy in Serious Mental Illness: Emerging Evidence
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“The first suggestive clinical evidence for the potential efficacy of the ketogenic diet in psychotic disorders emerged 55 years ago in a small, open-label, uncontrolled trial in 10 women hospitalized with schizophrenia. The ketogenic diet was added to their existing treatment for 4 weeks. The researchers reported a significant decrease in symptoms after 2 weeks on the diet (Pacheco et al., 1965).
In 2009, a 70-year-old woman with chronic schizophrenia since her teens was reported to have improved significantly after starting a ketogenic diet for weight loss (Kraft and Westman, 2009). Within 8 days of starting the diet, she reported no hallucinations and improved energy. After 1 year, she lost 5 kg and remained free of hallucinations.”