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

## TL;DR

A patient with treatment-resistant PTSD showed significant improvement after following a ketogenic diet for 25 weeks, suggesting metabolic therapy may be a promising new approach.

## Contribution

This case report introduces ketogenic metabolic therapy as a novel intervention for treatment-resistant PTSD linked to metabolic dysfunction.

## Key findings

- The patient's PTSD symptoms, measured by PCL-5, PHQ-9, and GAD-7, showed significant improvement over 27 weeks of the ketogenic diet.
- Qualitative reports indicated enhanced mood stability and cognitive function alongside reduced depressive and anxiety symptoms.
- The results suggest that addressing metabolic dysfunction through KMT may offer clinical benefits for PTSD patients unresponsive to conventional treatments.

## Abstract

This case report examines the application of ketogenic metabolic therapy (KMT), also known as the ketogenic diet, in a patient with treatment-resistant Post-Traumatic Stress Disorder (PTSD) resulting from military sexual trauma (MST) who was nonresponsive to conventional interventions including psychotherapy and pharmacotherapy. Metabolic dysfunction can contribute to persistent symptoms highlighting the need for novel treatment approaches.

A retrospective analysis was conducted on a 45-year-old female patient who underwent a structured ketogenic dietary intervention for 25 weeks. Therapeutic carbohydrate restriction was initiated by the patient 9 days before formal treatment with rapid and early improvements in mood prior to working with the KMT professional. Clinical response was monitored using validated instruments, including Post-Traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 (PCL-5), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Depression Anxiety Stress Scales-42 (DASS-42), as well as daily metabolic measurements assessing nutritional ketosis.

Quantitative assessments demonstrated significant clinical improvement. The PCL-5 score decreased from 32 at the intervention baseline to 2 at 27 weeks. The PHQ-9 score declined from 10 to 0 and the GAD-7 score decreased from 6 to 0. DASS-42 further confirmed the resolution of depressive, anxious, and stress symptoms. Qualitative data corroborated these findings, with the patient reporting enhanced mood stability, improved cognitive function, and a renewed sense of emotional wellbeing.

Targeted KMT may be effective against the metabolic dysfunction underlying treatment-resistant PTSD. The consistent improvements across multiple psychometric assessments, supported by qualitative reports, warrant further controlled investigations into the clinical utility of this intervention.