This case series presents the use of a ketogenic metabolic therapy (KMT) to achieve complete remission of major depression and generalized anxiety disorder (GAD) in three adults with complex psychiatric comorbidities. The patients, aged 32 to 36, were treated with a personalized whole food animal-based ketogenic diet (1.5:1 ratio) for 12 to 16 weeks, along with various clinical supports and lifestyle therapies. The treatment led to significant improvements in depression and anxiety, as measured by the PHQ-9 and GAD-7 scales, respectively. All patients experienced increased flourishing and self-compassion, and one patient achieved optimal metabolic health. The study highlights the potential of KMT as a therapeutic intervention for major depression and GAD, particularly in individuals with complex psychiatric and metabolic conditions. The authors emphasize the need for further research to understand the biological mechanisms and optimal implementation of KMT in clinical practice.This case series presents the use of a ketogenic metabolic therapy (KMT) to achieve complete remission of major depression and generalized anxiety disorder (GAD) in three adults with complex psychiatric comorbidities. The patients, aged 32 to 36, were treated with a personalized whole food animal-based ketogenic diet (1.5:1 ratio) for 12 to 16 weeks, along with various clinical supports and lifestyle therapies. The treatment led to significant improvements in depression and anxiety, as measured by the PHQ-9 and GAD-7 scales, respectively. All patients experienced increased flourishing and self-compassion, and one patient achieved optimal metabolic health. The study highlights the potential of KMT as a therapeutic intervention for major depression and GAD, particularly in individuals with complex psychiatric and metabolic conditions. The authors emphasize the need for further research to understand the biological mechanisms and optimal implementation of KMT in clinical practice.