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Remission of obsessive-compulsive disorder using ketogenic metabolic therapy in support of exposure and response prevention: a retrospective case report
Obsessive Compulsive Disorder (OCD) is a chronic and crippling mental illness that frequently does not improve with standard therapies like exposure and response prevention (ERP) and selective serotonin reuptake inhibitors (SSRIs). This case study by Laurent & Tague (2025) investigates the use of ketogenic metabolic therapy (KMT) alongside ERP in treating a 26-year-old male with treatment-resistant OCD, primarily presenting with symmetry and ordering compulsions. The patient experienced a complete remission of OCD symptoms, along with lasting improvements in mood, emotional stability, and overall quality of life. The patient followed a modified ketogenic diet with a fat-to-protein-plus-carbohydrate ratio of 1.5:1 for 12 weeks, aiming to maintain nutritional ketosis (≥0.8 mmol/L ketones). He also underwent ERP sessions targeting his specific compulsive behaviors and tracked daily symptoms. The severity of OCD symptoms was evaluated using the Dimensional Obsessive-Compulsive Scale (DOCS), while emotional well-being was measured using the Depression Anxiety Stress Scales (DASS-21). Outcomes were monitored over a 95-week-long term follow-up, and three weeks into KMT and ERP, the patient’s compulsive behaviors dropped dramatically, from 3–8 hours per day to under one hour. These improvements were maintained through the 95-week follow-up. DOCS scores for the symmetry/ordering dimension significantly declined, and DASS-21 scores returned to normal by week 7. The patient reported enhanced emotional control, better sleep, and greater ERP engagement, which he attributed to the ketogenic diet. This case illustrates a rapid and enduring remission of OCD symptoms when KMT is used in combination with ERP. The results suggest that KMT might provide a supportive metabolic environment that enhances ERP effectiveness. Further studies are needed to explore KMT’s potential as an adjunctive treatment for refractory OCD. [NPID: Ketogenic metabolic therapy, ketogenic diet, obsessive-compulsive disorder, OCD, exposure and response prevention, ERP, metabolic psychiatry, case report]
Year: 2025
