First Peer-Reviewed Expert Consensus on the Use of Ketogenic Therapy for Serious Mental Illness

The 33 statements were then used to create a list of recommendations, intended to inform key considerations for clinicians wishing to employ KMT for schizophrenia, bipolar disorder, and major depressive disorder.

Adjunctive Use:
KMT should be considered as an adjunct therapy to first-line treatments for major depressive disorder, bipolar disorder, and schizophrenia.

Who KMT is For:
A trial of KMT is appropriate for most adults living with these conditions, including individuals who cannot access, do not tolerate, or have not sufficiently benefited from first-line treatments.

Signs of Metabolic Dysfunction Not Required:
KMT is appropriate for individuals showing signs of metabolic dysfunction, but the absence of observable signs of metabolic dysfunction should not preclude individuals with schizophrenia, bipolar disorder, or major depressive disorder from a trial of KMT.

Team-Based Care:
Individuals using KMT to treat serious mental illness should be supported by a dietitian/licensed nutritionist or health coach trained in KMT and a prescribing clinician, or a prescribing clinician with training in KMT.

Safety Screening and Baseline Labs:
Prior to consideration of KMT, a thorough medical and psychiatric history should be taken to assess for absolute and relative contraindications (including rare inborn errors of metabolism affecting fatty acid transport/oxidation). Before initiating KMT, a baseline assessment including CBC, CMP, fasting lipid profile, vitamin D, vitamin B12, and a carnitine panel is recommended.

Ketone Targets:
Blood ketone levels should be monitored, especially in the initiation phase. While a BHB concentration of 0.5 mmol/L indicates a state of ketosis, many patients may require levels to be consistently maintained at 1.0 mmol/L or higher for best outcomes.

Trial Duration:
Barring any medical or psychiatric complications, for a trial of KMT to be considered adequate, a state of ketosis should be maintained for at least 3 consecutive months before drawing conclusions about effectiveness (unless earlier discontinuation is necessary).

Why This Consensus Matters:
As interest in metabolic psychiatry grows, clinicians need structured frameworks to implement ketogenic therapy responsibly. This paper is the first step in delivering expert guidance to clinicians who may want to add KMT as a tool in their toolbox.

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If you are a clinician, consider sharing this paper with colleagues exploring metabolic approaches in psychiatry.

If you are a patient or family member, consider sharing this interview and the paper with your care team to support an informed discussion about whether metabolic strategies may be appropriate in your individual case.