Low-carbohydrate diet as a disease modifier for relapse prevention of treatment-resistant depression. Spotlight on neuroplasticity and brain-derived neurotrophic factor

Abstract

Depression is the most common mental disorder with a high treatment resistance rate that can affect patients at any age. Individuals who obtain insufficient and unsatisfactory responses after two treatment steps are considered as treatment-resistant-depression (TRD), and therefore seek other both pharmacological and nonpharmacological modalities that may offer not only alleviation of depressive symptoms, but also prevent relapse of the disease. Dietary interventions, whether focusing on supplementation or dietary restrictions seem to match these criteria. Low-carbohydrate-diet (LCHD), which is a close family to ketogenic diet, has been shown to improve neuroplasticity by increasing production of brain-derived neurotrophic factor (BDNF) that has been decreased in patients with depression, yet naive to depression treatment. Furthermore, links between neuroplasticity deterioration and diet rich in sweetened beverages have been demonstrated as impaired cognitive performance and increased risk of depression. Here, we hypothesize that BDNF could be the common end-point intervention in TRD, that could be relatively easily achieved by reduction in carbohydrate consumption.