Psychiatric Disorders

Transdiagnostic remission of psychiatric comorbidity in post-traumatic stress disorder, ADHD, and binge-eating disorder using ketogenic metabolic therapy: a retrospective case report

This case report describes a 12-week ketogenic metabolic therapy (KMT) intervention in a 38-year-old woman with multiple comorbidities: treatment-resistant PTSD, ADHD, binge-eating disorder, depression, anxiety, and bipolar II disorder. After limited success with years of psychotherapy and no psychiatric medication, she enrolled in a structured KMT program with weekly support.

The dietary protocol included an animal-based ketogenic diet, progressing from a 1.5:1 to 2:1 ratio of fat to protein-plus-carbohydrate. She maintained daily blood ketone monitoring, achieving optimal mental clarity when beta-hydroxybutyrate levels remained between 3.0 and 5.0 mmol/L. No additional therapies were used during the intervention.

By week 12, all psychiatric symptoms had resolved based on multiple validated scales. She also reported significant functional improvements, including returning to work, enhanced focus, and greater emotional stability.

Key Findings:

• Depression (PHQ-9): Decreased from 27 (severe) to 0, indicating full remission of depressive symptoms.
• Anxiety (GAD-7): Dropped from 16 (severe) to 0, reflecting complete resolution of anxiety.
• PTSD (PCL-5): Fell from the maximum score of 80 to 0, reflecting full remission of PTSD symptoms.
• Binge Eating Symptoms (BES): Reduced from 44/46 (severe) to 0, indicating complete cessation of binge episodes.
• Food Addiction (CRAVED): Declined from 6/6 to 0, suggesting resolution of addictive eating behaviors.
• Stress, Depression, and Anxiety (DASS-21 Total): Improved from 80 to 0, with all subscales in the normal range by week 12.

By week 12, all psychiatric symptoms had resolved based on multiple validated scales. The patient also reported significant functional improvements, including returning to work, enhanced focus, and greater emotional stability.  She reported rapid symptom return during brief lapses from ketosis and described maintaining ketone levels as critical to her mental health.

These results suggest that KMT may offer a targeted approach for complex psychiatric conditions and warrants further study.