The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of 31 Inpatients

Albert Danan, Eric C Westman, Laura R Saslow, Georgia Ede, Albert Danan, Eric C Westman, Laura R Saslow, Georgia Ede

Abstract

Background and hypothesis: The robust evidence base supporting the therapeutic benefit of ketogenic diets in epilepsy and other neurological conditions suggests this same metabolic approach may also benefit psychiatric conditions.

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.

Keywords: bipolar disorder; depression; diet therapy; inpatients; ketosis; mental disorders; schizophrenia.

Conflict of interest statement

EW received consulting fees from Hill United Health and founded Adapt Your Life, Inc. (equity interest)—both companies founded on low-carbohydrate-diet principles—and received royalties for books that recommend a carbohydrate-restricted diet. GE reports stock options in DietDoctor.com, a company founded on low-carbohydrate principles. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Danan, Westman, Saslow and Ede.

Figures

Figure 1
Figure 1
Change in Clinical Global Impressions Severity Scale (CGI-S) Over Time. Severity of illness was assessed in 27 of 28 patients using the CGI-S. The CGI-S is rated on a scale of 1 to 7, with 1 indicating normal and 7 indicating extreme illness. Following the KD intervention, CGI-S had improved in all 27 patients, with 12 of 27 (44%) achieving a CGI-S of 1 (clinical remission).
Figure 2
Figure 2
Changes in Psychotropic Medication. Changes in the number and/or dosage of psychotropic medications associated with KD intervention are represented in this figure. The majority (64%) of participants were discharged on less medication.

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