FPIN's Help Desk Answers
Probiotics for Symptoms of Depression and Anxiety
Am Fam Physician. 2018 Mar 15;97(6):online.
Are probiotics effective for the treatment of symptoms of depression and anxiety?
A combination of three probiotic species slightly improves symptoms in patients with major depressive disorder. (Strength of Recommendation [SOR]: B, based on a small randomized controlled trial [RCT].) Lactobacillus casei alone does not affect depressive symptoms in patients with chronic fatigue syndrome, but it does improve anxiety. (SOR: C, based on a low-quality small RCT.)
A 2016 RCT evaluated the clinical effect of probiotics on major depressive disorder.1 Forty patients 20 to 55 years of age who had been diagnosed with major depressive disorder were recruited from an Iranian hospital. Treatment and control groups were well-matched except for higher baseline fasting glucose levels in the probiotic group. Patients received a capsule containing three viable, freeze-dried probiotic strains (n = 20; Lactobacillus acidophilus, 2 × 109 colony-forming units [CFU] per g; L. casei, 2 × 109 CFU per g; and Bifidobacterium bifidum, 2 × 109 CFU per g) or placebo (n = 20) every day for eight weeks. They were instructed to not change their usual physical activity or diet and to avoid any additional supplements or medications. There were no statistically significant differences in self-reported diet or activity. The outcome measure was the total score on the Beck Depression Inventory, a 21-item questionnaire scored 0 to 63, with scores higher than 30 indicative of severe or extreme depression. Patients who received probiotic supplements had a mean reduction of 5.7 points compared with a reduction of 1.5 points in the placebo group (P = .001). Differences remained after adjustment for baseline differences in fasting glucose levels. Limitations of the study included uncertainty regarding which strain of probiotic led to the treatment effect, the study duration, and small sample size.
A 2009 RCT evaluated the effectiveness of probiotics on symptoms of
1. Akkasheh G, Kashani-Poor Z, Tajabadi-Ebrahimi M, et al. Clinical and metabolic response to probiotic administration in patients with major depressive disorder: a randomized, double-blind, placebo-controlled trial. Nutrition. 2016;32(3):315–320.
2. Rao AV, Bested AC, Beaulne TM, et al. A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome. Gut Pathog. 2009;1(1):6.
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