Ketogenic diet in therapy of bipolar affective disorder – case report and literature review

Abstract

Bipolar affective disorder is a chronic mental disorder, characterized by mood swings alternating between depression and manic or hypomanic episodes. Unfortunately, in some patients pharmacological treatment is not effective, and a certain group of patients shows treatment resistance. Therefore, other treatment methods are sought after, including a change in diet. The most promising is the ketogenic diet. In the presented case study of a male patient, thanks to the introduction of the ketogenic diet, full remission of the disease was achieved, doses of lamotrigine were reduced and quetiapine was completely discontinued. Previously, neither lamotrigine monotherapy nor combined treatment with quetiapine achieved euthymia. The effects of the diet may be related to, among others, the influence on ionic channels and increase in blood acidity (similar to the use of mood stabilizers), increase in gamma-aminobutyric acid (GABA) concentration, modulation of GABAA receptors, effects on the concentration of catecholamines, blocking of AMPA receptors by medium-chain fatty acids, with significant share of omega-3 fatty acids, reduction in insulin levels, and changes in the gut microbiota. The ketogenic diet influences glutamate metabolism and nerve cell metabolism, which uses ketone bodies as energy sources. Ketosis can also stimulate biogenesis of mitochondria, improve brain metabolism, act as a neuroprotective factor, as well as increase glutathione synthesis and reduce oxidative stress. Due to the limited size of the present study, literature review includes selected papers published in the last two decades in the PubMed and Google Scholar scientific literature databases, in English and Polish, with the following key words: ketogenic diet, bipolar affective disorder, depression, schizophrenia.