Research indicates that following a keto diet can be an effective form of metabolic treatment for depression, particularly atypical and treatment-resistant forms. Dr. Erin Bellamy has seen ketogenic therapy’s success through her online program Integrative Ketogenic Research and Therapies, which helps patients implement a keto diet for mental health conditions and effectively coordinate with their prescriber and health care team for the best treatment outcomes.

Can ketogenic therapy help with depression?

Dr. Erin Bellamy: We have some fantastic case studies and some fantastic research results coming through now showing, you know, great improvements in quite a short period of time. Perhaps that could be due to the mechanisms of the ketones and how the mechanisms are working on the mechanisms of bipolar disorder or schizophrenia. Maybe they're a little bit different perhaps to how they work within depression.

But then when you look at depression on the whole, unfortunately, we have this what I like to coin an umbrella term. I think depression is an umbrella term because underneath that there are subtypes. You know, we have melancholic depression, atypical depression, and some other different types of depression, and they all have different symptomatology and different symptoms.

And within that, for example, within atypical depression, the symptoms might be increased hunger, cravings, and weight. But then with melancholic depression, it's complete absence of hunger, you know, losing weight. And so I think we're in a sticky situation there because you have two people with depression just with different subtypes and they have very different symptomatology and very different experiences with the atypical.

There is research to show that there's a lot of overlap with metabolic syndrome. And so I think if people out there have depression with atypical subtype, you know, they may lean more favorably for a ketogenic diet.

However, we know from the work of Dr. Chris Palmer and Dr. Iain Campbell, and so on, that overall, these ketones are improving our metabolic health. On the surface, they're improving our metabolic health on the whole and providing us with energy.

So when you look at depression, you have to look at the individual and their subtype and what they're experiencing. And I think everybody can benefit from either a short or long stint in ketosis because of the increase in brain energy. We could all do with a bout of it. However, I think those people who have the atypical subtype depression or the treatment-resistant depression seem to respond more quickly to the ketogenic diet.

How long does it take for medical keto to help with depression?

Dr. Erin Bellamy: As opposed to bipolar, schizoaffective disorder or schizophrenia, I have seen clinically that depression takes a little bit longer, but still within a 12-week mark. Some things improve quickly, but generally speaking, improvements are coming in four to six weeks. The energy improvement comes almost instantly, which I think is consistent with what most people see because of the increase in ketones, but the anxiety and the mood are slowly improving over a period of time.

Don't get disheartened if you don't see the results straight away. It's not that you're not doing something right or you're doing something wrong. It may just be that you need. It's just going to take a little bit longer.

And as long as you're working with somebody who's monitoring everything with you and is looking out for the right things, then you know, just stick with them and monitor over time and look for that gradual improvement.

Can keto for depression be personalized?

Dr. Erin Bellamy: We're all so different and we all have our own experiences. How did we get to depression? Was it bereavement? Was it an adverse life event during childhood? Was it inflammation? Maybe I have an autoimmune condition or arthritis that triggered a depressive episode. So, there are so many routes.

I think that then lends to the fact that this is such a personalized approach.  So, I don't think we will ever have a cookie cutter. This is the ketogenic diet that you're going to do and you're going to expect these benefits. It doesn't work like that, just like cancer therapy or any other therapy is personalized to the individual.

Ketogenic metabolic therapy has to be personalized to the individual because you may also have some comorbidities, for example, where you overlap with another condition. You may even have you maybe you have a combination of two mental health conditions and then maybe you also have some anxiety thrown in or some seasonal affective disorder. All of those things need to be considered for you as the individual and then a plan is put in place.

Generally speaking, you're still looking for ketones, right? But once you have the ketogenic diet as the foundation, you start adding the other things that you think might be able to help that individual that's personalized to them.

Can ketogenic therapy be an adjunctive treatment option for depression?

Dr. Erin Bellamy: This is something that I come across time and time again, and I understand because if I was on medication for anything and if I didn't feel like I needed to or wanted to be on it, I would want to get off it as quickly as possible. And if there was even the idea that I could try something else, I would try something else and then try and come off it.

And so when people come to me with that, that same need, I have to explain to them that we're going to do this alongside your current standard of care. There's going to be no medication changes for the three months you're doing this because we're changing this one thing.

Your psychiatrist will change medications, but most likely it's going to stay the same for this period of time. And then if you are starting to see improvements, then you can talk to your psychiatrist about maybe reducing some of the medications, tapering the medications in a way that only they know how with you.

And that can take a very long time, you know, a very small amount at a time. Sometimes you need to go up, sometimes you need to come back down. But you can't just come off your medication and just do the ketogenic diet because it's not safe.

But also what I like to say to people is, “Listen, the long-term goal is for you to feel better and to live the life that makes you happy. You need to be able to have the energy to do the things you want to do in life. And if that means being on a ketogenic diet and still being on some medication, but you're feeling good, you're doing everything that you want to do, you're getting out with your kids, you're getting up in the morning, you're doing your degree, whatever it is, if you're still able to do those things and you're still on a perhaps a low-level level of medication and the rest is the ketogenic diet, well, then that's not so bad.”

Some people might be able to come off their medication completely. Other people might not, you know, or it might just take them a longer time. It really is about just setting those expectations. The main goal is just for people to feel better. And if that does include some medications, well then so be it. And then just putting in all these other lifestyle interventions around them to support them metabolically.

If you enjoyed reading this, take some time to watch the full interview with Dr. Erin Bellamy on YouTube.