Awareness and best practices in using ketogenic therapy to treat serious mental illness: a modified Delphi consensus

Background Metabolic dysfunction is emerging as an important contributor to the pathophysiology of major depressive disorder, bipolar disorder, and schizophrenia, fueling interest in ketogenic metabolic therapy (KMT) as a potentially beneficial intervention for serious mental illness. KMT has been used successfully for decades in treating epilepsy, but evidence for treating mental illness has yet to mature. Aims This study aimed to produce expert-informed guidance for the implementation of KMT in adults with serious mood and psychotic disorders. Method A modified Delphi methodology was used to examine the opinions of KMT-experienced mental health experts. A steering group of eight such experts convened to develop an online survey comprising 33 statements regarding 1) the definition of KMT in the context of serious mood and psychotic illness; 2) identification of eligible candidates; 3) monitoring and measurement standards; and 4) best practices in employing KMT. This survey was distributed to clinician peers to examine opinions. The threshold for consensus agreement was set a priori at 75%. Result Consensus was reached for all 33 statements (100%); therefore, the steering group approved the complete series of recommendations. Conclusions This consensus provides expert-informed guidance to support the use of KMT in adults with major depressive disorder, bipolar disorder, and schizophrenia.