Awareness and best practices in using ketogenic therapy to treat serious mental illness: a modified Delphi consensus

Abstract:

Background: 

Metabolic dysfunction is emerging as an important contributor to the pathophysiology of major depressive disorder, bipolar disorder, and schizophrenia, fueling interest in ketogenic metabolic therapy (KMT) as a potentially beneficial intervention for serious mental illness. KMT has been used successfully for decades in treating epilepsy, but evidence for treating mental illness has yet to mature.

Aims: 

This study aimed to produce expert-informed guidance for the implementation of KMT in adults with serious mood and psychotic disorders.

Method: 

A modified Delphi methodology was used to examine the opinions of KMT-experienced mental health experts. A steering group of eight such experts convened to develop an online survey comprising 33 statements regarding 1) the definition of KMT in the context of serious mood and psychotic illness; 2) identification of eligible candidates; 3) monitoring and measurement standards; and 4) best practices in employing KMT. This survey was distributed to clinician peers to examine opinions. The threshold for consensus agreement was set a priori at 75%.

Result: 

Consensus was reached for all 33 statements (100%); therefore, the steering group approved the complete series of recommendations.

Conclusions: 

This consensus provides expert-informed guidance to support the use of KMT in adults with major depressive disorder, bipolar disorder, and schizophrenia.