Effects of Psychotropics on the Microbiome in Patients With Depression and Anxiety: Considerations in a Naturalistic Clinical Setting

Abstract

Background The antibacterial effects of psychotropics may be part of their pharmacological effects when treating depression. However, limited studies have focused on gut microbiota in relation to prescribed medication. Method We longitudinally investigated the relationship between patients’ prescribed medications and intestinal bacterial diversity in a naturalistic treatment course for patients with major depressive disorders and anxiety disorders. Patients were recruited and their stool was collected at three time points during their usual psychiatric treatments. Gut microbiota were analyzed using 16S rRNA gene sequencing. We examined the impact of psychotropics (i.e., antidepressants, anxiolytics, antipsychotics) on their gut microbial diversity and functions. Result We collected 246 stool samples from 40 patients. Despite no differences in microbial diversity between medication groups at the baseline, over the course of treatment, phylogenic diversity (PD) whole tree diversity decreased in patients on antipsychotics compared to patients without (p=0.027), and beta diversity followed this trend. Based on a fixed-effect model, antipsychotics predicted microbial diversity; the higher doses correlated with less diversity based on the Shannon index and PD whole tree (Estimate = -0.00254, SE = 0.000595, p < 0.0001; Estimate = -0.02644, SE = 0.00833, p = 0.002, respectively). Conclusion Antipsychotics may play a role in decreasing the alpha diversity of the gut microbiome among patients with depression and anxiety, and our results indicate a relationship with medication dosage. Future studies are warranted and should consider patients’ types and doses of antipsychotics in order to further elucidate the mechanisms of gut-brain interactions in psychiatric disorders.

Probiotic consumption relieved human stress and anxiety symptoms possibly via modulating the neuroactive potential of the gut microbiota

“…Bastiaanssen et al point out the gut microbiota responds to stress similarly on the functional level but not on the taxonomical level in different host model ( Bastiaanssen et al, 2021 ). Similarly, Tomizawa et al found that the gut microbial function involved in Gut-Brain is influenced by the psychotropic consumption ( Tomizawa et al, 2020 ). Collectively, the taxa encoded the GBM seemed to be major players participating in stress resilience, more work is needed to determine the changes of GBM after probiotics consumption.…”

Case report: Carbohydrate malabsorption in inpatients with anorexia nervosa

“…An accompanying drug 10.3389/fpsyt.2022.1076658 therapy against tension and depression was indicated for patient 5 (quetiapine 25 mg) and has already been taken by the patient since 2019. Although psychotropics may alter gut microbiota diversity, no data exist so far for low-dose quetiapine (29).…”

Treating Bugs as Features: A compositional guide to the statistical analysis of the microbiome-gut-brain axis

“…Prime among these are the production of metabolites like short-chain fatty acids and neuroactive compounds in the microbiome, modulating the immune system and direct stimulation of the vagus nerve Cryan et al (2019). Besides playing an important role in gut-brain communication during health and homeostasis, the microbiome has also been found to be affected by psychotropic medication Maier et al (2018); Tomizawa et al (2020). In some cases, the microbiome can even metabolize psychotropic medication such as L-DOPA, which is commonly prescribed for Parkinson's disease, altering the concentration of L-DOPA reaching the patient and thus efficiency of the treatment Maini Rekdal et al (2019).…”