Summary:
Depression is a common and costly condition that affects a substantial proportion of adults globally and has increased sharply since the COVID-19 pandemic, particularly among young adults and students. Although psychotherapy and antidepressant medications are effective for many individuals, these treatments can be associated with side effects and may not address underlying metabolic disturbances that are increasingly linked to depression. This study was an intervention study that examined whether a well-formulated ketogenic diet could be used alongside mainstream treatment for major depressive disorder (MDD). A well-formulated ketogenic diet is characterised by very low carbohydrate intake, moderate protein consumption, and higher fat intake, leading to a metabolic state known as ketosis. This dietary pattern has consistently been shown to improve metabolic outcomes in people with insulin resistance and obesity. However limited human evidence suggests that higher ketone levels may be associated with reduced depressive symptoms, particularly in individuals with metabolic disease. This study included twenty-four university students receiving counselling and/or medication who were enrolled in a 10-12 week ketogenic diet program that included dietary education and daily monitoring of blood ketone levels. Mood symptoms were assessed alongside measures of metabolic health, body composition, cognitive performance, and blood-based hormonal and inflammatory markers. Sixteen participants completed the intervention and achieved nutritional ketosis for the study period. Large reductions in depressive symptoms were observed, with improvements occurring within the first few weeks. Participants also reported improvements in overall wellbeing. Significant reductions in body weight, fat mass, and circulating leptin were observed, alongside increases in brain-derived neurotrophic factor and improvements in cognitive tasks. These findings indicate that, in students with mild to moderate depression, a ketogenic diet is feasible as an adjunct therapy and may be associated with meaningful improvements in mood, metabolic health, and cognitive function.
Abstract:
A ketogenic diet (KD) has shown promise as an adjunctive therapy for neurological and neuropsychiatric disorders, including bipolar disorder and major depressive disorder (MDD). We examined tolerance for a KD in young adults with MDD and assessed symptoms of depression and metabolic health. Students (n = 24) with a confirmed diagnosis of MDD at baseline receiving standard of care counseling and/or medication treatment were enrolled in a 10–12 week KD intervention that included partial provision of ketogenic-appropriate food items, frequent dietary counseling, and daily morning tracking of capillary R-beta-hydroxybutyrate (R-BHB). Primary outcome measures for mood symptoms included the Patient Health Questionnaire (PHQ-9) and Hamilton Rating Scale for Depression (HRSD). Additional outcomes included body composition, neurocognitive function, and blood hormonal and inflammatory markers. Sixteen students (10 women, 6 men, mean age 24 yr) completed the intervention. Nutritional ketosis (R-BHB > 0.5 mM) was achieved 73% of the time. Depressive symptoms decreased by 69% (PHQ-9) and 71% (HRSD) post-intervention (p < 0.001), with improvement occurring within 2–6 weeks. Global well-being increased nearly 3-fold (p < 0.001). Participants lost body mass (−6.2%; p = 0.002) and fat mass (−13.0%; p < 0.001). Serum leptin decreased (−52%; p = 0.009) and brain-derived neurotropic factor increased (+32%; p = 0.029). Performance improved on several cognitive tasks. In students with mild to moderate depression based on PHQ-9 and HRSD, implementation of a WFKD for 10–12 weeks is a feasible adjunctive therapy and may be associated with improvements in depression symptoms, well-being, body composition, and cognition.
Article Publication Date: 10/09/2025
DOI: 10.1038/s41398-025-03544-8
