- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06105762
Ketogenic Diet for Depression (KETO-MOOD)
KETO-MOOD: Ketogenic Diet for Microbiome Optimization and Overcoming Depression
Study Overview
Status
Intervention / Treatment
Detailed Description
Major depressive disorder (MDD) is the second leading contributor to the global burden of chronic diseases, as measured by years lived with disability. Additionally, MDD is associated with an increased risk of developing various conditions such as diabetes mellitus, heart disease, cancer, and stroke, which further adds to the disease burden. Notably, MDD significantly increases the risk of suicide, with up to 50% of the 800,000 worldwide suicides occurring during a depressive episode. The prevalence of mental disorders has been on the rise in Western societies, coinciding with the nutritional decline in typical Western diets. Traditional, nutrient-rich foods have been progressively replaced by ultra-processed foods, which are linked to heightened health risks, including type-2 diabetes, cardiovascular diseases, cancer, and depression. The ketogenic diet is a unique dietary approach that drastically limits carbohydrate intake, inducing a state of ketosis characterized by elevated levels of circulating ketone bodies. Ketone bodies, namely acetoacetate, β-hydroxybutyric acid, and acetone, are primarily produced through ketogenesis in the liver's mitochondrial matrix. Ketosis can be achieved through fasting or by consuming a low-carbohydrate diet, typically containing fewer than 20 grams of net carbs per day. Ketosis has historical roots and was a common physiological state during human evolution, particularly in the Paleolithic era when social structures were based on small groups of hunter-gatherers. In modern medicine, the ketogenic diet has been employed for nearly a century to treat refractory epilepsy. Although there is compelling evidence of the positive effects of the ketogenic diet on the brain and mental well-being, research on its effectiveness in psychiatric illnesses is still emerging. Ketosis may address various pathologies associated with depression, including frontal glucose hypometabolism, imbalances in GABA/glutamate neurotransmitter signaling, oxidative stress, mitochondrial dysfunction, inflammation (both cerebral microglial dysfunction and low-grade systemic inflammation), and perturbations in the gut microbiome. The primary hypothesis of our study is that adherence to a high-fat (≥60%) ketogenic diet, in addition to standard psychiatric care, will lead to a reduction in depressive symptoms at 4 and 8 weeks following the intervention, compared to standard psychiatric care involving a balanced mixed diet consisting of around 60% carbohydrates, with moderate amounts of fats and protein.
This study is a prospective, assessor-blinded, controlled trial with a randomized, parallel-arm design, categorized as a phase 2 trial. The focus of the study centers on a nutritional intervention as the independent variable, and it will be conducted at the University Psychiatric Clinics (UPK) in Basel, Switzerland. Participants will undergo supervised dietary training and counseling over the course of 8 weeks. The 8-week observation period is crucial for determining the effectiveness of prescribed depression treatments. Individuals eligible for the study are those who meet the diagnostic criteria for (unipolar) major depressive disorder or are currently experiencing a depressive episode within the context of bipolar affective disorder, according to ICD-10 criteria. Participants will be randomly assigned to receive either a low-carbohydrate (<20g/day) ketogenic diet or a standard balanced mixed diet. Any discussion regarding diets between assessors and patients (or trial partners) will be strictly prohibited during the trial. Dietary support will be provided, primarily in the initial days, to ensure diet adherence, address issues, and monitor potential adverse effects. Dietitians will offer guidance on setting up and maintaining the diet, utilizing recipe cards, meal planning, dietary resources, and assisting with common challenges. The MAD ketogenic diet approach will be utilized in this study, as it has shown improved adherence compared to the classic ketogenic diet, with similar anti-seizure efficacy.
The ketogenic diet presents several benefits due to its non-pharmacological nature, demonstrating safety and over a century of efficacy in epilepsy management. Emerging evidence suggests its potential advantages in addressing metabolic and neuropsychiatric conditions, potentially exceeding the effectiveness of traditional antidepressant treatments, without the associated risks of third-line interventions such as ketamine application and electroconvulsive therapy. Moreover, the ketogenic diet is cost-effective and can be self-administered by patients, enhancing their sense of self-efficacy.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Timur Liwinski
- Phone Number: +41 61 325 5544
- Email: Timur.Liwinski@upk.ch
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion criteria:
- Unequivocal diagnosis of major depressive disorder or bipolar depression according to ICD-10 and ICD-11 (as soon as approved in Switzerland) criteria
- Age ≥18 years
- The patient can give informed consent as documented by signature
- Interest in trying a dietary intervention
- Participants must refrain from using any non-prescribed psychotropic agents during the study period including alcohol and illicit drugs such as cannabis; long term pain medication, caffeine and nicotine are excluded from that rule
Exclusion criteria:
- Inability to follow the study procedures, e.g., because of a language barrier, neurological and interfering mental disorders, dementia
- Anorexia nervosa
- BMI <18.5 kg/m2
- Pregnancy or breast feeding
- Current electroconvulsive therapy (ECT)
- Concurrent ketamine therapy
- Inability to follow the procedures of the study, e.g. due to language barrier, neurological and interfering mental disorders, high-grade dementia, etc.
- Porphyria
- Type 1 diabetes
- Insulin-dependent type 2 diabetes
- Contraindicated medical conditions; besides rare hereditary metabolic disorders (typically diagnosed in childhood), contraindications comprise acute pancreatitis, nephrolithiasis, advanced renal failure, advanced liver failure, advanced congestive heart failure, advanced pulmonary disease with respiratory failure, and concurrent use of SGLT2 inhibitors
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Ketogenic Diet Arm
During an 8-week period, individuals enrolled in the experimental group will undergo a low-carbohydrate, high-fat ketogenic diet intervention.
We will implement the Modified Atkins Diet (MAD), which is a nutritionally rich and diverse variant of the ketogenic diet.
It restricts net carbohydrate intake to less than 20g per day.
|
The ketogenic diet intervention, administered as a Modified Atkins Diet, involves a significantly reduced daily carbohydrate intake, typically less than 20 grams of net carbs.
This approach primarily relies on higher fat consumption to induce ketosis, a metabolic state characterized by elevated ketone body production, serving as an alternative brain fuel source.
Other Names:
|
Active Comparator: Conventional Healthy Mixed Diet Arm
The control group will be provided with a standard balanced mixed diet following the recommendations for healthy nutrition by the Schweizerische Gesellschaft für Ernährung (Société Suisse de Nutrition).
This diet will consist of an average daily caloric supply from carbohydrates of approximately 45 - 60%, as per the guidelines.
|
The ketogenic diet intervention, administered as a Modified Atkins Diet, involves a significantly reduced daily carbohydrate intake, typically less than 20 grams of net carbs.
This approach primarily relies on higher fat consumption to induce ketosis, a metabolic state characterized by elevated ketone body production, serving as an alternative brain fuel source.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Depressive Symptoms Severity
Time Frame: Baseline (week 0), week 4, week 8
|
|
Baseline (week 0), week 4, week 8
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Anxiety Symptoms Severity
Time Frame: Baseline (week 0), week 4, week 8
|
|
Baseline (week 0), week 4, week 8
|
Functioning
Time Frame: Baseline (week 0), week 4, week 8
|
|
Baseline (week 0), week 4, week 8
|
Hedonic Tone
Time Frame: Baseline (week 0), week 4, week 8
|
- Assessment Tool: Snaith-Hamilton Pleasure Scale (SHAPS)
|
Baseline (week 0), week 4, week 8
|
Sleep Quality
Time Frame: Baseline (week 0), week 4, week 8
|
- Assessment Tool: Insomnia Severity Index (ISI)
|
Baseline (week 0), week 4, week 8
|
Subjective Depressive Symptom Burden
Time Frame: Baseline (week 0), week 4, week 8
|
- Assessment Tool: Beck Depression Inventory II
|
Baseline (week 0), week 4, week 8
|
Changes in Serum Levels of Brain-Derived Neurotrophic Factor (BDNF)
Time Frame: Baseline (week 0), week 4, week 8
|
|
Baseline (week 0), week 4, week 8
|
Changes in Serum Level of Highly Sensitive C-Reactive Protein (hsCRP)
Time Frame: Baseline (week 0), week 4, week 8
|
- Assessment Tool: Ultrasensitive ELISA
|
Baseline (week 0), week 4, week 8
|
Changes in Fecal Metagenomics Shotgun Sequencing
Time Frame: Baseline (week 0), week 8
|
|
Baseline (week 0), week 8
|
Changes in Serum Metabolomics Profile
Time Frame: Baseline (week 0), week 8
|
- Assessment Tool: Liquid Chromatography-Mass Spectrometry (LC-MS)
|
Baseline (week 0), week 8
|
Collaborators and Investigators
Publications and helpful links
General Publications
- Francis H, Stevenson R. The longer-term impacts of Western diet on human cognition and the brain. Appetite. 2013 Apr;63:119-28. doi: 10.1016/j.appet.2012.12.018. Epub 2013 Jan 3.
- Gangwisch JE, Hale L, Garcia L, Malaspina D, Opler MG, Payne ME, Rossom RC, Lane D. High glycemic index diet as a risk factor for depression: analyses from the Women's Health Initiative. Am J Clin Nutr. 2015 Aug;102(2):454-63. doi: 10.3945/ajcn.114.103846. Epub 2015 Jun 24.
- Wheless JW. History of the ketogenic diet. Epilepsia. 2008 Nov;49 Suppl 8:3-5. doi: 10.1111/j.1528-1167.2008.01821.x.
- Mentzelou M, Dakanalis A, Vasios GK, Gialeli M, Papadopoulou SK, Giaginis C. The Relationship of Ketogenic Diet with Neurodegenerative and Psychiatric Diseases: A Scoping Review from Basic Research to Clinical Practice. Nutrients. 2023 May 11;15(10):2270. doi: 10.3390/nu15102270.
- Smolensky IV, Zajac-Bakri K, Gass P, Inta D. Ketogenic diet for mood disorders from animal models to clinical application. J Neural Transm (Vienna). 2023 Sep;130(9):1195-1205. doi: 10.1007/s00702-023-02620-x. Epub 2023 Mar 21.
- Norwitz NG, Sethi S, Palmer CM. Ketogenic diet as a metabolic treatment for mental illness. Curr Opin Endocrinol Diabetes Obes. 2020 Oct;27(5):269-274. doi: 10.1097/MED.0000000000000564.
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- KET6O1L
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Depressive Disorder
-
York UniversityCentre for Addiction and Mental HealthSuspendedDisorder, Major DepressiveCanada
-
Shalvata Mental Health CenterUnknownMAjor Depressive DisorderIsrael
-
Samsung Medical CenterUnknownMajor Depressive Disorder, Anxiety DisorderKorea, Republic of
-
Wyeth is now a wholly owned subsidiary of PfizerCompletedDepressive Disorder, Major Depressive DisorderUnited States
-
Seasons Biotechnology (Taizhou) Co., Ltd.CompletedMajor Depressive Disorder (MDD)India
-
Repurposed Therapeutics, Inc.Unknown
-
GlaxoSmithKlineCompletedMajor Depressive Disorder (MDD)United States
-
Seasons Biotechnology (Taizhou) Co., Ltd.CompletedMajor Depressive Disorder (MDDIndia
-
Gangnam Severance HospitalCompletedMajor Depressive Disorder(MDD)Korea, Republic of
-
University College, LondonCompletedUnipolar Major Depressive DisorderUnited Kingdom
Clinical Trials on Ketogenic Diet
-
Shriners Hospitals for ChildrenUniversity of HawaiiCompleted
-
University of PittsburghBaszucki Brain Research FundRecruitingBipolar DisorderUnited States
-
University of Roma La SapienzaCompleted
-
Kuopio University HospitalDeakin UniversityRecruitingPsychotic Disorders | Schizophrenia | Psychosis | Psychosis; AcuteFinland
-
University of FloridaRecruitingSeizuresUnited States
-
Mid-Atlantic Epilepsy and Sleep Center, LLCUnknown
-
Helse Nord-Trøndelag HFNorwegian University of Science and Technology; Vanderbilt University Medical... and other collaboratorsActive, not recruiting
-
University of Maryland, BaltimoreRecruiting
-
Ohio State UniversityRecruiting
-
University of PadovaUniversity of Palermo; Universidade Federal de GoiasCompleted