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Meta-Analysis
. 2019 Jul:102:13-23.
doi: 10.1016/j.neubiorev.2019.03.023. Epub 2019 Apr 17.

Prebiotics and probiotics for depression and anxiety: A systematic review and meta-analysis of controlled clinical trials

Richard T Liu  1 , Rachel F L Walsh  2 , Ana E Sheehan  2
Affiliations
Meta-Analysis

Prebiotics and probiotics for depression and anxiety: A systematic review and meta-analysis of controlled clinical trials

Richard T Liu et al. Neurosci Biobehav Rev. 2019 Jul.

Abstract

With growing interest in the gut microbiome, prebiotics and probiotics have received considerable attention as potential treatments for depression and anxiety. We conducted a random-effects meta-analysis of 34 controlled clinical trials evaluating the effects of prebiotics and probiotics on depression and anxiety. Prebiotics did not differ from placebo for depression (d = -.08, p = .51) or anxiety (d = .12, p = .11). Probiotics yielded small but significant effects for depression (d = -.24, p < .01) and anxiety (d = -.10, p = .03). Sample type was a moderator for probiotics and depression, with a larger effect observed for clinical/medical samples (d = -.45, p < .001) than community ones. This effect increased to medium-to-large in a preliminary analysis restricted to psychiatric samples (d = -.73, p < .001). There is general support for antidepressant and anxiolytic effects of probiotics, but the pooled effects were reduced by the paucity of trials with clinical samples. Additional randomized clinical trials with psychiatric samples are necessary fully to evaluate their therapeutic potential.

Keywords: Anxiety; Depression; Microbiome; Prebiotic; Probiotic.

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Figures

Figure 1.
Figure 1.
PRISMA flow chart of literature search
Figure 2.
Figure 2.
Forest plots of standardized effect sizes (Cohen’s d) of prebiotic and probiotic trials for depression and anxiety.
Figure 2.
Figure 2.
Forest plots of standardized effect sizes (Cohen’s d) of prebiotic and probiotic trials for depression and anxiety.
Figure 2.
Figure 2.
Forest plots of standardized effect sizes (Cohen’s d) of prebiotic and probiotic trials for depression and anxiety.
Figure 3.
Figure 3.
Funnel plot for effect sizes in the meta-analyses. The vertical line indicates the weighted mean effect. Open circles indicate observed effects for actual studies, and closed circles indicate imputed effects for studies believed to be missing due to publication bias. The clear diamond reflects the unadjusted weighted mean effect size, whereas the black diamond reflects the weighted mean effect size after adjusting for publication bias.
Figure 3.
Figure 3.
Funnel plot for effect sizes in the meta-analyses. The vertical line indicates the weighted mean effect. Open circles indicate observed effects for actual studies, and closed circles indicate imputed effects for studies believed to be missing due to publication bias. The clear diamond reflects the unadjusted weighted mean effect size, whereas the black diamond reflects the weighted mean effect size after adjusting for publication bias.
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