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Can probiotics help with depression?

 

Update on the latest scientific publications

Individuals with depressive symptoms have a different composition of the gut microbiome than non-depressed people. Probiotics might provide an effective and safe alternative in the management of depressions. Animal studies provide evidence of the positive effect of probiotics on stress-related disorders, such as depression and anxiety. There is a growing body of evidence that so called psychobiotics also provide benefits to healthy and depressed humans.

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Depression

Depression is a growing public health concern. The World Health Organization currently estimates that depression affects about 322 million people worldwide, which is a proportion of 4.4% of the total population [1]. Depression can be present in many forms; mild or severe and long lasting or recurrent. It can substantially impair an individual’s ability to function at work or school or cope with daily life. At its most severe, depression can lead to suicide.

 

 

Microbiome gut-brain axis

 

In recent years, the bidirectional link between gut and brain has gained a lot of attention. There is growing evidence that the gut can affect brain function and behavior. For example, there is a clear association between imbalances in the gut microbiota and stress-related disorders such as anxiety and depression [2]. The exact mechanisms are still unknown, but they include neural, endocrine, immune, and metabolic pathways. The vagus nerve is a fundamental neural route of communication between gut and brain. [3]  

 

Researchers have found that the microbial composition in people with depression differs from that of non-depressed people. Depressed people tend to have less Bifidobacteria and Lactobacilli and more Bacteroidetes, Proteobacteria and Actinobacteria [2]. This suggests that modulating the gut microbiome could have an effect on depressive symptoms.

 

 

Is there a role for probiotics?

Pre- and probiotics can have a major influence on the bidirectional communication between the gut and the brain. The anti-inflammatory and immune-regulatory properties and the ability of many bacteria to synthesize and release neurotransmitters may help in tackling the underlying causes of depression [3,4].   In rodents, there is evidence that probiotics can have a positive effect on depression. Probiotics seem to downregulate the -in depression- overactive HPA-axis, and improve levels of the neurotransmitters GABA and serotonin, which are both reduced in depressed persons [3,5,6].

 The anti-inflammatory and immune-regulatory properties and the ability of many bacteria to synthesize and release neurotransmitters may help in tackling the underlying causes of depression 

 

 

Research in healthy and depressed individuals

Several researchers analyzed the beneficial effects of probiotics in healthy individuals. Recently, McKean et al [7] reviewed 9 randomized controlled trials (RCTs) and concluded out of data of 394 persons that supplementation with probiotics resulted in signi´Čücantly reduced preclinical psychological symptoms of anxiety, depression and stress in healthy individuals. Bruce-Keller et al [6] confirmed the beneficial effects of probiotics on mood, based on 3 RCTs.  

 

Research in clinical populations with mood and mental disorders is emerging. Wallace [8] and Huang [9] described in their reviews that probiotics may have a positive effect on depressive symptoms in people with mild to moderate depression. More recently, Ng et al [4] concluded that in 3 RCT’s people with mild to moderate depression, probiotics had a significant positive effect on mood. The authors emphasize that none of the participants showed any adverse effects from using probiotics, which usually isn’t the case with the standard medication (SSRI).

 

Future research

The evidence of the positive effects of probiotics on depression becomes more robust, but since it is a relatively new research area a lot of work still has to be done. One of the challenges is to find out which combination of probiotics is most effective. It is thought that multi-strain probiotics are more effective than single-strain probiotics. [10,11]. Most researchers used a cocktail of probiotics and especially a combination of specific Lactobacilli and Bifidobacteria seems to be effective. It still has to be determined which exact species can best be used. Also the exact mechanisms of how probiotics influence depression have not yet been unraveled.

The studies on depression are in line with the role of probiotics in other mood and mental disorders, like anxiety and stress. More research in this field will help clarify where novel interventions may be possible.

 

 

References

1.       World Health Organization, 2017. Depression and Other Common Mental Disorders: Global Health Estimates. http://www.who.int/mental_health/management/depression/prevalence_global_health_estimates/en/   2.       Kim, N., Yun, M., Oh, Y.J., Choi, H.J. Mind-altering with the gut: Modulation of the gut-brain axis with probiotics. J Microbiol. 2018 Mar;56(3):172-182.  

3.       Dinan, T.G., Cryan, J.F. Brain-Gut-Microbiota Axis and Mental Health. Psychosom Med. 2017 Oct;79(8):920-926.  

4.       Ng, Q.X., Peters, C., Ho, C.Y.X., Lim, D.Y., Yeo, W.S. A meta-analysis of the use of probiotics to alleviate depressive symptoms. J Affect Disord. 2018 Mar 1;228:13-19. 

5.       Liu, X., Cao, S., Zhang, X. Modulation of gut microbiota– brain axis by probiotics, prebiotics, and diet. J Agric Food Chem 2015;63:7885–7895. 46.  

6.       Bruce-Keller, A.J., Salbaum, J.M., Berthoud, H.R. Harnessing Gut Microbes for Mental Health Getting From Here to There. Biol Psychiatry. 2018 Feb 1;83(3):214-223  

7.       McKean, J., Naug, H., Nikbakht, E., Amiet, B., Colson, N. Probiotics and Subclinical Psychological Symptoms in Healthy Participants: A Systematic Review and Meta-Analysis. J Altern Complement Med. 2017 Apr;23(4):249-258.  

8.       Wallace, C.J. and R. Milev, The effects of probiotics on depressive symptoms in humans: a systematic review. Ann Gen Psychiatry, 2017. 16: p. 14.  

9.       Huang, R., K. Wang, and J. Hu, Effect of Probiotics on Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients, 2016. 8(8)  

10.   Mason, B.L. Feeding Systems and the Gut Microbiome Gut-Brain Interactions With Relevance to Psychiatric Conditions. Psychosomatics. 2017 Nov - Dec;58(6):574-580.  

11.   Mohajeri, M.H., La Fata, G., Steinert, R.E., Weber, P. Relationship between the gut microbiome and brain function. Nutr Rev. 2018 Apr 26.

 

 

Can probiotics support in depression

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