Millions of people are living with mental illness throughout the world. The psychiatric labels for their diagnoses include clinical depression, anxiety disorders, bipolar disorder, schizoaffective disorder, schizophrenia, and obsessive-compulsive disorder, among others.
- diminished pleasure in things that used to be pleasurable, or complete inability to experience joy
- mood instability
- sleep disruption
- delusions (firm beliefs not based in reality)
- visual and auditory hallucinations (seeing and hearing things that others don’t)
- disorganized thought processes
- memory impairment
- anxiety, intrusive thoughts, and more.
It isn’t surprising that the current symptom-focused diagnostic criteria often overlap with each other. Many people meet criteria for more than one psychiatric diagnosis.
Having a mental illness can be crippling.
Symptoms often appear during childhood, adolescence, or early adulthood. For many, it strikes just as their futures are forming. For some, the illness begins as a slow progressive decline. For others, the illness can have an acute onset. In any case, those who suffer and their loved ones sometimes see potentially bright futures fade away.
Current Treatments Offer Some Hope – and Others Despair
Treatments work for many people, and promoting access to care is important and critical. All too often, however, people suffering from mental disorders don’t get adequate care. Shame, stigma, poor insurance coverage, and overbooked clinicians can all interfere with people accessing adequate care. Unfortunately, though, even when people do get appropriate care, far too many continue to suffer. Current treatments primarily address the symptoms, not the cause. In fact, no one knows for sure what causes mental illnesses. Treatment-resistant mental illness is far too common. For those who aren’t getting better, mental illness can be devastating and scary for everyone involved.
Using the ketogenic diet to treat epilepsy
The ketogenic diet is a popular, trendy, weight-loss diet. Interestingly, though, it’s nothing new. It has been around since 1921, when it was first developed by a physician to treat seizures. After 98 years of studies, it has been proven to be an effective treatment for epilepsy, even treatment-resistant epilepsy. Could it also be an effective treatment for mental illness?
Could the ketogenic diet treat mental illness as well?
Emerging evidence suggests it might play a role in treating mental illness. We already know that many medications for epilepsy are also used to treat psychiatric disorders. Some inspiring case reports (1, 2, 3) and studies suggest a low-carb or ketogenic diet, a dietary treatment for epilepsy, can be a very effective treatment for some people with mental illness. This may come as a surprise. However, there is an evolving understanding that there is a bidirectional relationship between mental illness and epilepsy. In light of this relationship, the idea of common treatments is not so surprising after all.
Are mental and medical illnesses interrelated?
In order for an illness to be diagnosed as “purely mental’, all other known physical causes must first be excluded. However, maybe it is an open question, are these illnesses “strictly mental” or could a physical issue be a root cause? There is good reason to think that a biological basis may be a cause of psychiatric symptoms. Well-documented common threads between mental, medical, and neurological illnesses exist. In comparison to people without diagnosed psychiatric disorders, those with mental illness are far more likely to also suffer cardiovascular disease, diabetes, and obesity. (4, 5, 6, 7, 8, 9, 10, 11, 12) Conversely, those with these medical conditions are more likely to develop a major mental illness in their lifetimes. (Ibid.)
Epilepsy and psychiatric illness have a bidirectional relationship
There is a similarly well-documented, bidirectional relationship between epilepsy and a number of different psychiatric illnesses. This includes a bidirectional association between epilepsy and major depressive disorder, mood disorders, anxiety disorders, dysthymia and, panic disorder/agoraphobia.(13, 14, 15, 16) This means that if you have been diagnosed with a mental illness you are statistically more likely to either have epilepsy or develop it, and vice versa. One of many examples is that patients with epilepsy develop psychosis or schizophrenia at a rate exceeding that which would be expected if the two disorders were totally independent.(17)
Mental illness often comes first
It is tempting to disregard this bidirectional relationship. The obvious argument is that having a neurological disorder as serious as epilepsy would make anyone sad, anxious, or worse. However, the data also suggests that in many cases a diagnosis of a mental illness comes before the first seizure.
A diagnosis of major depression was identified as a six-fold risk factor for later suffering unprovoked seizures (e.g., seizures not caused by head trauma, virus, or similar event). (18) Similarly, studies documented an almost three-fold increase in the risk of suicide attempts in future epilepsy patients, before the diagnosis of epilepsy was ever made. After an epilepsy diagnosis, researchers found an additional two-fold increase risk for recurrent suicide attempts.(19) Overall, suicide is three times more frequent in epilepsy patients than in the unaffected population. It is noteworthy that the depressive symptoms often come before the onset of epilepsy.(20)
A related pathophysiology for epilepsy and mental illness?
This does not mean that every person with epilepsy will have or will develop a mental illness. It also doesn’t mean that every person with a mental illness will have or develop epilepsy. However, the data establishing the bidirectional relationship between these illnesses, which both impact the brain, does suggest a relationship worth exploring. After all, both epilepsy and mental illness impact brain health. The correlation between epilepsy and mental illness could yield important information about cause and effect. Perhaps they have a shared or related pathophysiology. Insights about this possibility would be of interest to many millions of those who suffer treatment resistant mental illness and other brain health issues. They also might suggest, common therapies.
Effectiveness of current standard treatments for mental illness
Medications are currently the first line treatment for mental illness. Healthcare providers often combine these meds with talk therapy and other behavior-based interventions. The standard treatments for mental illness can be very effective for the fortunate few. But, far too many find their illness to be treatment-resistant. Some never experience any relief.
The lucky few find the right dose of the right medication at the right time relieves some symptoms. But even for those, medication doesn’t always continue to relieve symptoms over time. These limitations of standard treatments for mental illness are frustrating for patients, providers, and caregivers. This frustration also affects many people diagnosed with epilepsy, their providers, and caregivers. Highlighting another similarity between these two disorders.
Challenging side effects
Many suffer serious medication side effects. These side effects can include tremendous weight gain, diabetes, and increased risk of cardiovascular disease. Paradoxically, these medications can also increase the very symptoms that they are supposed to be treating, for example, they can cause an increase in psychotic symptoms like paranoia and hallucinations. Also, they can bring about suicidal ideations, agitation, and impaired cognition. The search for relief can be overwhelming for these patients. This is true both for those who do not get relief from the medications and/or those who suffer serious medication side-effects.
Conclusion – Diet for mental illness may be a useful medical intervention
It is important to note that it can also be very hard to distinguish between medication side effects and the illness itself. Despair is an understandable reaction to all the difficulties facing those diagnosed with mental disorders. This is especially so for patients who spend years seeking and not finding relief in the current standard treatments offered to them. New treatment ideas are desperately needed. Better outcomes are desperately needed.
This article has been heavily derived from “Ketogenic Therapy for Brain and Mental Health.” Chris Palmer, MD, and Anne Rauch wrote the original for the Charlie Foundation.
Psychiatrist with a clinical practice at McLean Hospital in Belmont, Massachusetts. Director of the Department of Postgraduate and Continuing Education, and Assistant Professor of Psychiatry at Harvard Medical School. He has been using the ketogenic diet to treat his patients for more than 15 years.
Anne L. Rauch
Anne is a practicing lawyer in California. She investigated traditional and alternative treatments for mental illness to help a close family member. He suffered an acute onset mental/metabolic illness at the age of 15. He benefits dramatically from the medical ketogenic diet.
Anne founded The Paradox Foundation, a nonprofit, to support research into safe, effective treatments for mental illness.
- Palmer C, Gilbert J, Westman E. “The Ketogenic Diet and Remission of Psychotic Symptoms in Schizophrenia: Two Case Studies.” Schizophrenia Research. 2019; April 6, 2019
- Palmer C. “Chronic Schizophrenia Put Into Remission Without Medication – New research suggests ketogenic diet may play a role in treating schizophrenia.” Psychology Today. April 6, 2019.
- Palmer C, Rauch Anne, “Ketogenic Therapy for Brain and Mental Health.” Charlie Foundation for Ketogenic Therapies. 2019, April.
- McIntyre RS, Konarski JZ, Wilkins K, Soczynska JK, Kennedy SH. Obesity in bipolar disorder and major depressive disorder: results from a national community health survey on mental health and well-being. Can J Psychiatry. 2006;Apr;51(5):274-80. [PubMed] [Google Scholar]
- Strassnig M, Clarke J, Mann S, Remington G, Ganguli R. Body composition, pre-diabetes and cardiovascular disease risk in early schizophrenia. Early Interv Psychiatry. 2017;Jun;11(3):229-236. doi: 10.1111/eip.12225. [Google Scholar]
- Simon, GE, Von Korff, M, Saunders, K, Miglioretti, D. L., Crane, PK, van Belle, G, & Kessler, RC. Association between obesity and psychiatric disorders in the US adult population. Archives of general psychiatry. 2006;63(7), 824-30. [Google Scholar]
- Rajkumar AP, Horsdal HT, Wimberley T, Cohen D, Mors O, Børglum AD, Gasse C. Endogenous and Antipsychotic-Related Risks for Diabetes Mellitus in Young People With Schizophrenia: A Danish Population-Based Cohort Study. Am J Psychiatry. 2017;Jul 1;174(7):686-694. doi: 10.1176/appi.ajp.2016.16040442. [Google Scholar]
- Lassale C, Batty GD, Baghdadli A, Jacka F, Sánchez-Villegas A, Kivimäki M, Akbaraly T. Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies. Mol Psychiatry. 2018; Sep 26. doi: 10.1038/s41380-018-0237-8. Erratum in: Mol Psychiatry. 2018;Nov 21.
- Pillinger T, Beck K, Gobjila C, Donocik JG, Jauhar S, Howes OD. Impaired Glucose Homeostasis in First-Episode Schizophrenia: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2017;Mar 1;74(3):261-269. doi:10.1001/jamapsychiatry.2016.3803. [Google Scholar]
- Sun L, Min L, Li M, Shao F, Wang W. Transcriptomic analysis reveals oxidative phosphorylation activation in an adolescent social isolation rat model. Brain Res Bull. 2018;Sep;142:304-312. doi:10.1016/j.brainresbull.2018.08.013.
- Fan H, Yu W, Zhang Q, Cao H, Li J, Wang J, Shao Y, Hu X. Depression after heart failure and risk of cardiovascular and all-cause mortality: a meta-analysis. Prev Med. 2014;Jun;63:36-42. doi: 10.1016/j.ypmed.2014.03.007. [Pub Med]
- Lett HS, Blumenthal JA, Babyak MA, Sherwood A, Strauman T, Robins C, Newman MF. Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment. Psychosom Med. 2004; May-Jun;66(3):305-15. [Google Scholar]
- Tellez-Zenteno, J.F. Patten, S.b., Jette, N. Psychiatric comorbidity in epilepsy: A population-based analysis. Epilepsia. 2007;48(12), 2336-2344. doi:10.111/j.1528-1167.2007.0122.x. [Google Scholar]
- Reilly C, Atkinson, P, Das B. Neurobehavioral Comordities in Children with Active Epilepsy: A Population-Based Study. Pediatrics, 2014;133(6), 1586-1593. [Google Scholar]
- Blanca Vasquez, B, Devinsky O. Epilepsy and Anxiety. Epilepsy & Behavior. 2003;4, S20-S25. [PubMed]
- Wiglusz MS, Landowski J, Cubala WJ. Prevalence of Anxiety Disorders in Epilepsy. Epilepsy and Behavior. 2018;79(2), 1-3. Doi: 10.1016/j.yebeh.2017.11.025.
- Hyde TM, Weinberger DR. Seizures and schizophrenia. Schizophr Bulletin. 1997;23(4), 611-622. [PubMed] [Google Scholar]
- Hesdorffer DC, Hauser WA, Annegers, JF. Major depression is a risk factor for seizures in older adults. Annals of Neurology. 2001;47(2), 246-249. [PubMed]
- Elger CE, Johnston SA, Hoppe C. Diagnosing and treating depression in epilepsy. Seizure. 2017;44(1), 184-193. [PubMed] [Google Scholar]
- Mula, M. Depression in epilepsy. Current Opinion in Neurology. 2017;30(2). 180-186. [PubMed] [Google Scholar]