Psychiatric Disorders

Ketogenic metabolic therapy for treatment-resistant post-traumatic stress disorder (PTSD): a retrospective case report

This retrospective case report examined the use of ketogenic metabolic therapy (KMT) in a 45-year-old woman with treatment-resistant post-traumatic stress disorder (PTSD) related to military sexual trauma. Despite nearly two decades of psychotherapy and multiple medication trials, the patient continued to experience severe PTSD symptoms, depression, anxiety, dissociation, and suicidal ideation.

The intervention consisted of a structured 25-week ketogenic diet, initiated independently by the patient 9 days before formal guidance. A 1.5:1 ketogenic ratio was implemented, providing approximately 77% fat, 18% protein, and 5% net carbohydrates (20 g/day), with regular virtual follow-up and metabolic monitoring. Therapeutic ketosis (≥1.5 mmol/L β-hydroxybutyrate) was achieved with structured support.

Validated psychometric tools were used throughout, including the PCL-5, PHQ-9, GAD-7, DASS-42.

Results

PTSD Severity (PCL-5):

• Baseline score: 32 (collected after initial carbohydrate restriction).
• Week 25 score: 2, indicating remission.
• Historical residential treatment score had previously been 64.

Depression (PHQ-9): Decreased from 10 (moderate) to 0 by week 21 and sustained at week 25.

Anxiety (GAD-7): Reduced from 6 (mild) to 0 by week 25.

DASS-42: Total score declined from 38 (severe depression component) to 0 by week 25.

Weight & Body Composition:

• Weight decreased from 142.7 lbs (64.7 kg) to 128.0 lbs (58.1 kg).
• Fat mass decreased to 29.8 lbs (13.5 kg).

Qualitative Outcomes:

• Resolution of suicidal ideation.
• Improved emotional regulation, cognitive clarity, and relational functioning.
• Enhanced resilience and psychological stability.

Conclusion

This case report documents full symptom remission in a patient with treatment-resistant PTSD following 25 weeks of KMT. Improvements were observed across multiple validated instruments and supported by qualitative reports of functional recovery. While causality cannot be established and confounders cannot be excluded, the findings support further controlled investigation of ketogenic metabolic therapy as a potential adjunctive intervention in treatment-resistant PTSD.