Can a change of attitude alleviate depression that no longer responds to medication? A British study published in the journal JAMA Psychiatry looked at the
ketogenic dietvery rich in fats and very low in carbohydrates, as a solution for patients lacking solutions.
In people with treatment-resistant depressionclassic antidepressants fail. It is estimated that nearly 1 in 3 patients with depression do not fully respond to antidepressants. Enough to fuel the idea that a targeted diet could change the situation.
Ketogenic diet and resistant depression: what the clinical trial shows
The ketogenic diet (KD), a high-fat, low-carbohydrate diet that modifies cellular energy metabolism from glucose to ketones, has been proposed as a novel treatment for several psychiatric disorders, including depression. But the studies are based on limited or questionable methodologies. To avoid these biases, the team from the University of Oxford conducted a randomized clinical trial in the United Kingdom. In total, 88 adults suffering from at least moderate resistant depression (i.e. with a score greater than or equal to 15 in the standardized 9-point PH-9 questionnaire, which ranges from 0 to 27) followed for six weeks either a ketogenic diet very low in carbohydrates, with prepared meals and measurement of ketones, or a more classic “phyto” diet, rich in fruits, vegetables and vegetable oils, with the same weekly monitoring. Rous were suffering
Both groups were better, but a little more so on the ketogenic diet: the PHQ-9 score fell by around 10.5 points compared to 8.3 with the control diet. “This randomized controlled trial found small improvements in depression in people with treatment-resistant depression when a ketogenic diet was used as an adjunct to pharmacological treatment“, summarized the authors.
Why This Diet Could Help Depression…and Why It’s Not So Simple
THE ketogenic diet pushes the body to burn fat and produce ketone bodies, an alternative fuel for the brain. Some work suggests a possible effect on brain energy, inflammation or the microbiota, but these mechanisms remain poorly understood. In the study, ketone levels were not clearly linked to symptom improvement.
The setting of the trial also matters a lot: meals delivered, regular contact, feeling of being surrounded. “One possible reason why patients improved during the study, whether they followed the ketogenic diet or the control diet, is likely that they received a lot of support“, observed Raphael Braga, doctor at Zucker Hillside Hospital, in the New York Post. The additional effect of the ketogenic drug seemed especially marked in the most severe forms.
Should You Try a Ketogenic Diet for Treatment-Resistant Depression?
Faced with these results, psychiatrists remain cautious. “No one in psychiatry is prepared to recommend this as a research-validated treatment method for treatment-resistant depression“, warned psychiatrist Gail Saltz in Everyday Health. The ketogenic diet remains very restrictive and socially restrictive. This is recognized by the authors who admit that “adherence to the diet required significant support, and few patients chose to continue it after that support stopped“. Furthermore, its long-term effects remain poorly understood, although the trial did not report any serious events.
The authors are therefore talking about a first avenue, not a new recommendation. Such a diet does not replace antidepressants and may only be suitable for certain highly motivated patients. Anyone interested should discuss it with their doctor or psychiatrist, consider specialized nutritional monitoring and never change their treatments alone. Other less radical dietary changes are also being studied to support the management of depression.