Psychiatric Disorders

A retrospective evaluation of an online group ketogenic metabolic therapy intervention on mental health outcomes

Depression and anxiety are common mental health conditions, yet many individuals do not achieve sustained improvement with conventional treatments such as antidepressants and psychotherapy. Interest is growing in metabolic approaches to mental health, including ketogenic metabolic therapy (KMT), which may influence brain energy metabolism, inflammation, and neurotransmitter balance.

This study retrospectively evaluated the feasibility and mental health outcomes of a remotely delivered, group-based ketogenic metabolic therapy program. The intervention combined nutritional ketosis with structured education, professional guidance, and peer support delivered online. Participants followed a Modified Atkins–style ketogenic diet with individualized macronutrient targets while tracking food intake and blood ketone(beta-hydroxybutyrate) levels.

Nineteen self-referred adults with depression and anxiety ranging from mild to severe based on PHQ-9 and GAD-7 scores. Psychological assessments were conducted at baseline and again at 4, 8, and 12 weeks. Most participants had previously tried multiple treatments, including medications and psychotherapy, and many continued existing therapies during the program but did not begin new treatments during the intervention period.

Results / Key Findings

Depression (PHQ-9)

• Mean PHQ-9 scores decreased from 13 to 5, representing a 62% reduction in depressive symptoms.
• 71% of participants achieved a clinically meaningful improvement (≥5-point reduction).
• 47% reached remission (PHQ-9 <5).
• Overall, 88% experienced improvement in depressive symptoms at some point during the intervention.

Anxiety (GAD-7)

• Mean GAD-7 scores decreased from 13 to 7, representing a 46% reduction in anxiety symptoms.
• 79% of participants achieved a clinically meaningful improvement (≥4-point reduction).
• 47% reached remission (GAD-7 ≤5).
• All participants experienced some improvement in anxiety during the intervention.

Ketosis and Adherence

• Participants maintained beta-hydroxybutyrate (BHB) levels ≥0.5 mmol/L about 85% of the time, indicating strong adherence.
• The average BHB level was 1.1 mmol/L, consistent with nutritional ketosis.
• No participants dropped out during the 12-week intervention.

Safety

• Mild temporary symptoms during adaptation to the diet included fatigue, headache, irritability, and sleep difficulty.
• All symptoms resolved within two weeks with dietary guidance.
• No serious adverse events were reported.

Conclusion

This retrospective evaluation suggests that a remote, group-based ketogenic metabolic therapy program may be a feasible and effective approach for improving symptoms of depression and anxiety.  The fully online format suggests potential for scalable delivery to individuals who may have limited access to in-person care.

However, the findings should be interpreted cautiously due to the small sample size, lack of a control group, and self-selected participants. Larger controlled studies with longer follow-up are needed to confirm these results and determine how ketogenic metabolic therapy could be integrated into broader mental health care systems.