The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of 31 Inpatients.
Level 4 - case-series / case-control
Retrospective uncontrolled case series
PubMed 35873236 · doi:10.3389/fpsyt.2022.951376
What was done
A retrospective analysis evaluated 31 adult inpatients with severe, persistent mental illness (major depressive disorder, bipolar disorder, and schizoaffective disorder) refractory to standard psychiatric care. Patients received an adjunctive ketogenic diet restricted to ≤20 grams of carbohydrate per day alongside conventional inpatient care, with intervention duration ranging from 6 to 248 days. Three patients who could not adhere to the diet for more than 14 days were excluded from the final analysis.
What was found
Among the 28 analyzed patients, mean (SD) Hamilton Depression Rating Scale scores improved from 25.4 (6.3) to 7.7 (4.2) (P < 0.001) and Montgomery-Åsberg Depression Rating Scale scores improved from 29.6 (7.8) to 10.1 (6.5) (P < 0.001). In the subset of 10 patients with schizoaffective disorder, Positive and Negative Syndrome Scale scores improved from 91.4 (15.3) to 49.3 (6.9) (P < 0.001). Statistically significant improvements were also reported in weight, blood pressure, blood glucose, and triglycerides.
Why it matters
This study provides preliminary clinical signals that carbohydrate restriction may be feasible and therapeutically relevant in severe, treatment-refractory psychiatric disorders, warranting controlled trials.
Limits
The study is an uncontrolled, retrospective chart review with a small sample (n=31 total, 28 analyzed; only 10 with psychosis). Confounding from concurrent inpatient treatments, medication changes, and hospitalization effects cannot be excluded. Treatment duration varied substantially (6 to 248 days), and per-protocol exclusion of non-adherent patients introduces attrition bias.
Cited by
- supports Ketogenic diets are being clinically investigated and used as metabolic therapies for severe mental illnesses including schizophrenia and bipolar disorder.