Controversial diet may help drug-resistant depression: study

Feeling persistently down? A surprising solution might be found in your kitchen. A new study suggests a specific dietary approach could offer relief for individuals struggling with severe, treatment-resistant depression, with potential improvements observed within six weeks.

A Lifeline for Those Who Haven’t Found Relief

This research offers a potential turning point for a significant portion of the population. Approximately 30% of Americans diagnosed with Major Depressive Disorder do not respond to conventional treatments, leaving them to cope with ongoing and often worsening symptoms that disrupt daily life. An estimated 3 million people in the US suffer from treatment-resistant depression.

The Ketogenic Diet and Brain Health

The study focused on the ketogenic diet – a high-fat, moderate-protein, low-carbohydrate eating plan. This diet aims to shift the body into a metabolic state called ketosis, where it primarily burns fat for energy instead of sugar.

This metabolic shift results in the production of ketones, which can serve as an alternative fuel source for both the brain and muscles. Scientists have long theorized that ketones could have beneficial effects on brain function. Previous research indicates they may provide a more stable energy supply, influence neurotransmitters like serotonin, reduce inflammation, and even contribute to improved gut health – all factors linked to depression.

How the Study Was Conducted

Researchers enrolled 88 adults, aged 18 to 65, who had been diagnosed with treatment-resistant depression. Participants were divided into two groups. One group followed a strict ketogenic diet, consuming three prepared meals and snacks daily while monitoring ketone levels in their urine.

The other group adhered to a “phytochemical” diet, which involved incorporating a different colored fruit or vegetable into each meal and replacing saturated animal fats with unsaturated plant oils. Both diets were followed for six weeks.

Promising, But Not Simple, Results

At the conclusion of the study period, both groups showed improvements. Depression scores decreased by an average of 10.5 points in the keto group, compared to an average decrease of 8.3 points in the phytochemical group. Urine tests confirmed that most participants in the keto group successfully maintained ketosis during the intensive support phase.

However, maintaining the ketogenic diet long-term proved challenging. After the structured meal plan and weekly support ended, only 9% of participants continued to follow the keto diet.

“The main take away message from the study basically is that the ketogenic might have some value when well done, but it’s a very hard measure to take,” explained Dr. Raphael Braga, who was not involved in the study. “It’s very restricted.”

Beyond Diet: The Importance of Support

Researchers believe that metabolism plays a role in the potential benefits of keto for severe depression. Research suggests ketones may address underlying metabolic issues associated with depression, such as insulin resistance and mitochondrial dysfunction, by providing brain cells with more efficient fuel. However, diet alone may not be the complete answer.

“One of the possible reasons why patients throughout the study got better, either the ketogenic diet or the control diet that the study used, is probably because they had a lot of support,” Braga explained. Participants received prepared meals, regular check-ins, assistance with tracking their progress, and weekly counseling sessions. “Those are very important for patients, especially with the treatment of severe presentations of depression.”

Braga emphasized the importance of social engagement, stating, “The more we can do to help patients engage socially with family and friends or programs,” the better.

Considerations and Next Steps

The ketogenic diet is widely recognized as a tool for weight loss and has gained popularity among athletes, bodybuilders, and celebrities like Halle Berry and Kourtney Kardashian. However, it’s not without potential drawbacks. Some studies have linked keto to poorer diet quality and increases in LDL “bad” cholesterol. One 12-week study indicated higher cholesterol levels, increased apolipoprotein B, and reduced levels of beneficial gut bacteria in participants following a keto diet.

Braga suggests that other lifestyle modifications, such as weight management, exercise, and establishing routines, can also be beneficial for individuals whose depression hasn’t responded to standard treatments. “If a patient at this stage is taking care of their own health and losing weight or maintaining a healthy weight, this would be in itself a major gain and that would be very effective on its own,” he said.

If these findings are replicated in larger studies, it’s possible that dietary interventions, particularly when combined with comprehensive support systems, could become a more integrated part of treatment plans for treatment-resistant depression. Further research may also explore which specific metabolic pathways are most affected by the ketogenic diet and how these changes relate to improvements in mood and cognitive function. We see also possible that other dietary approaches, beyond keto and the phytochemical diet used in this study, could offer similar benefits.

Frequently Asked Questions

What percentage of Americans with Major Depressive Disorder don’t respond to standard treatments?

Approximately 30% of Americans with Major Depressive Disorder do not respond to standard treatments.

What is ketosis?

Ketosis is a metabolic state where the body burns fat for energy instead of sugar.

Did participants in the keto group continue the diet after the study ended?

No, only 9% of participants continued eating keto after the prepared meals and weekly support ended.

Given these initial findings, how might personalized dietary approaches be incorporated into mental healthcare in the future?