The Effect of Synbiotic as an Adjuvant Therapy to Fluoxetine in Moderate Depression: A Randomized Multicenter Trial

Abstract

Background: Depression is a serious and burdensome disorder in modern societies, with lifetime prevalence of about 16%. Disturbed immune responses in the gut and immune-privileged sites including the central nervous system might occur subsequent to dysbiosis of gut microbiome. In this study we aimed at assessing the efficacy of 6 weeks synbiotic supplementation in the treatment of moderate depression in a double-blind, placebo-controlled, multi-center, and randomized trial. Methods: A total of 40 adult outpatients, who met the diagnostic and statistical manual of mental disorders fifth edition for moderate depression, were recruited based on the structured interview for DSMV. Recruited patients had a Hamilton rating scale for depression (HAM-D) score of 17 to 23 at baseline. All patients received fluoxetine (20 mg/d) for 4 weeks. Then, either a synbiotic capsule (plus fluoxetine) or placebo (plus fluoxetine) was added to the therapy for 6 weeks. Results: The mean age of the participants in the synbiotic treated group was 34.45 years and it was 35.50 years in the placebo group. Following the adjustment of ANCOVA models for gender, age, and BMI at baseline, there was a greater reduction in HAM-D score in synbiotic treated patients (Mean ± SD =-19.25 ± 1.71) compared to placebo taking group (Mean ± SD =-17.75 ± 2.05; P = 0.024). At the end of the 10th week of the intervention and after applying ANCOVA adjusted for the mentioned variables as well as baseline HAM-D score, it was found that the synbiotic group had a significantly decreased HAM-D score compared to the placebo (3.65 vs. 4.80, P = 0.013). Conclusions: The results of the current study revealed the efficacy of synbiotic as an adjuvant therapy in moderate depression.

Gut-brain Axis and migraine headache: a comprehensive review

“…The role of gut microbiota in anxiety, depression and the HPA axis has been studied through assessing the effects of prebiotics and probiotics administration in these conditions [57][58][59]. It has been reported that "germ-free" mice may have increased plasma levels of serotonin and tryptophan.…”

Antidepressive Mechanisms of Probiotics and Their Therapeutic Potential

“…However, MSPs may have higher potency in humans. In MDD patients, SSP (L. plantarum) did not reduce depression but improved cognition (Lew et al, 2018), whereas MSPs had repeatedly shown antidepressive efficacy (Akkasheh et al, 2016;Bambling et al, 2017;Ghorbani et al, 2018;Kazemi et al, 2019). MSPs often gave better therapeutic efficacy compared to that of SSPs in gut-related disorders and pathogen infections, which could be explained by an overall higher dosage (Chapman et al, 2011(Chapman et al, , 2012.…”

“…Bifidobacterium bifidum and L. acidophilus were often included in the formulation of MSPs to treat depressive symptoms in patients with MDD (Akkasheh et al, 2016;Bambling et al, 2017;Ghorbani et al, 2018) and other health conditions, such as polycystic ovarian syndrome, multiple sclerosis and IBS (Kouchaki et al, 2017;Ostadmohammadi et al, 2019;Zhang et al, 2019). Surprisingly, B. bifidum and L. acidophilus have not been tested independently for its antidepressive effect.…”

Add‐on probiotics in patients with persistent allergic rhinitis: A randomized crossover clinical trial

“…Familact (Zist Takhmir Co., Tehran, Iran) is a probiotic mixture supplement that has shown efficacy in several diseases . Therefore, we conducted this randomized crossover clinical trial.…”

“…Familact (Zist Takhmir Co., Tehran, Iran) is a probiotic mixture supplement that has shown efficacy in several diseases. [13][14][15][16][17][18] Therefore, we conducted this randomized crossover clinical trial. The aim of this study was to assess the impact of add-on probiotic supplement on PAR symptoms and on the QoL of patients.…”