Depression: Probiotic supplements can help reduce symptoms

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Probiotics may aid the effectiveness of mental health treatments, according to new research. FreshSplash/Getty images
  • New research has shown that people with major depressive disorder who took probiotic supplements alongside standard antidepressant medications had reduced symptoms.
  • The findings suggest that probiotic supplementation could help adults with depression as a complementary therapy, but more research is needed.
  • Experts recommend incorporating probiotic-rich foods like yogurt, kefir, miso, and tempeh into your diet.

Antidepressants are typically the first line of treatment for people with major depressive disorder. However, between 15 and 30% of people with depression do not respond to these drugs.

According to a new study published in JAMA Psychiatryindividuals with major depressive disorder (MDD) who took probiotic supplements containing 14 strains of the bacteria demonstrated reduced symptoms of depression and anxiety.

The eight-week, double-blind, randomised, placebo-controlled study was conducted by researchers from the Institute of Psychiatry, Psychology & Neuroscience at Kings College London in collaboration with ADM Protexin.

The researchers wanted to explore the connection between improved gut health, specifically probiotic supplementation, and its effect on mental health.

They examined 50 outpatients diagnosed with major depressive disorder who scored above 13 on the Hamilton Depression Rating Scale (HAMD-17). Over the course of the study, participants took antidepressants for six or more weeks and were instructed not to make any changes.

In this study, 49 adults with major depressive disorder who failed to respond to prescription antidepressants were given either a 14-strain blend probiotic supplement or an identical placebo. Twenty-four participants took the probiotic.

While both groups showed improvement in symptoms throughout the study, further improvements were seen in the probiotic group from week four onward.

One particularly interesting finding was the change in anxiety scores, which has rarely been explored in studies of probiotics in depression, said Dr. Medical News Today.

This study is one of the first studies in a Western population to show both good tolerability of probiotics and positive effects on mental health in adults with depression who are currently taking antidepressants.

Dr. Viktoriya Nikolova, lead author of the study

The promising results led to the planning of a larger follow-up study.

Given the exciting results seen in this study, Professor Stone, the senior researcher on the study, is currently planning a larger follow-up study, but this has not yet been confirmed, Dr Nikolova added.

Our understanding of the gut microbiome and its impact on mental health is still in its infancy, said Dr. Benjamin Lerner, a gastroenterologist at Bridgeport Hospital and assistant professor of digestive diseases at Yale School of Medicine, who was not involved in the study.

We know that the human body is home to trillions of microorganisms, most of which live inside the intestines; we know that these microorganisms influence digestion, metabolism and inflammation; and we know that the brain and digestive system communicate via neural and hormonal signals, collectively referred to as the gut-brain axis, he explained.

However, it’s important to note that there is still much to be learned about the biological complexities of mental health and the gut microbiome.

The human brain and the gut microbiome are two of the most complex biological systems. They almost certainly influence each other in multiple ways, probably simultaneously, Dr. Lerner said.

Research supports the idea that probiotic supplementation could be an effective treatment method for altering gut-brain interactions.

The gut-brain axis is a concept that proposes a correlation between the gut microbiota and neuroendocrine-immune pathways, said Kelsey Costa, a dietitian nutritionist and health research specialist.

Emerging research suggests this connection is facilitated through a number of physiological and biochemical pathways, such as hormones, the immune system and the metabolic substrates produced by the microbiota, he said.

Dr. Lerner said the mechanism of how probiotic supplements can help with depression is still unknown.

Possible mechanisms include the production of neurotransmitters, which can affect mood, and the down-regulation of pro-inflammatory signaling molecules, called cytokines, he said.

The positive physical effects of a healthy gut microbiome can extend to a healthier state of mind.

Probiotic supplements may reduce symptoms of DCS by enhancing and redistributing microbiota species, maintaining intestinal barrier integrity, and reducing oxidative stress and inflammation. These benefits could extend to positive behaviors, mood, sleep, appetite and cognitive changes, improving overall mental health, Costa said.

This study adds to a growing body of evidence on the link between the gut microbiome and mental health and is an important step forward in understanding how probiotics can be used to support mental health.

Dr. Viktoriya Nikolova, lead author of the study

The biggest limitation of this study was its small sample size.

This particular study was quite small, with only 25 participants in each arm. Additionally, all participants received antidepressants in addition to probiotics. It’s not known whether the findings would hold up in a larger study or whether probiotics would have a positive effect in the absence of an antidepressant, said Dr. Lerner.

Also, not all probiotics are created equal.

Different species and strains are likely to impact the body in different ways, added Dr. Lerner.

There are studies that should change the way we treat patients and there are studies that should spur further research. This is one of those studies that should stimulate further research. In short, folks [with] depression should be encouraged to seek professional help and not self-treat with probiotics, she said.

There are a number of probiotic-rich foods that people can incorporate into their diet to help improve gut health.

I favor foods naturally rich in probiotics, such as yogurt, sauerkraut, miso, tempeh and kefir. Good sources of prebiotics (fiber-rich foods that promote the growth of beneficial bacteria) include whole grains, apples, bananas, onions, garlic, asparagus and artichokes, said Dr. Lerner.

Costa, meanwhile, has suggested the following foods to boost your probiotic intake:

  • Yogurt: Yogurts are one of the most popular probiotic sources in both dairy and non-dairy varieties. Widely available commercially, yogurt is an easy and convenient way to add probiotics to your diet.
  • Other dairy products: Cultured buttermilk, cheese, and other fermented dairy products like kefir are also common sources of probiotics.
  • Non-dairy foods: Excellent non-dairy options include probiotic-rich foods like miso, tempeh, sauerkraut, kimchi, natto, and pickles. You can also find probiotic strains in fermented grains, legumes, corn, pearl millet and sorghum.

Kombucha is a popular probiotic-rich beverage made from tea fermented with yeast and bacteria. Other non-dairy fermented beverages, such as coconut kefir, are becoming more available.

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