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Review
. 2021 Feb 8;10(4):647.
doi: 10.3390/jcm10040647.

Updated Review and Meta-Analysis of Probiotics for the Treatment of Clinical Depression: Adjunctive vs. Stand-Alone Treatment

Viktoriya L Nikolova  1 , Anthony J Cleare  1   2   3 , Allan H Young  1   2   3 , James M Stone  1   4
Affiliations
Review

Updated Review and Meta-Analysis of Probiotics for the Treatment of Clinical Depression: Adjunctive vs. Stand-Alone Treatment

Viktoriya L Nikolova et al. J Clin Med. .

Abstract

Recent years have seen a rapid increase in the use of gut microbiota-targeting interventions, such as probiotics, for the treatment of psychiatric disorders. The objective of this update review was to evaluate all randomised controlled clinical trial evidence on the efficacy of probiotics for clinical depression. Cochrane guidelines for updated reviews were followed. By searching PubMed and Web of Science databases, we identified 546 new records since our previous review. A total of seven studies met selection criteria, capturing 404 people with depression. A random effects meta-analysis using treatment type (stand-alone vs. adjunctive) as subgroup was performed. The results demonstrated that probiotics are effective in reducing depressive symptoms when administered in addition to antidepressants (SMD = 0.83, 95%CI 0.49-1.17), however, they do not seem to offer significant benefits when used as stand-alone treatment (SMD = -0.02, 95%CI -0.34-0.30). Potential mechanisms of action may be via increases in brain-derived neurotrophic factor (BDNF) and decreases in C-reactive protein (CRP), although limited evidence is available at present. This review offers stronger evidence to support the clinical use of probiotics in depressed populations and provides an insight into the mode of administration more likely to yield antidepressant effects.

Keywords: depression; meta-analysis; probiotics; systematic review.

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Conflict of interest statement

J.M.S., A.J.C., and A.H.Y. have received research grant support by ADM Protexin Probiotics Ltd (industrial partner of the MRC studentship by which V.L.N. is funded). V.L.N. has received honoraria for consulting from Janssen. J.M.S. has received honoraria for consulting from Janssen and research support from Takeda in the last 3 years. In the last 3 years, A.J.C. has received honoraria for speaking from Lundbeck and Janssen; honoraria for consulting from Allergan, Livanova, Janssen, and National Institute for Health and Care Excellence (NICE); and sponsorship for attending an academic conference from Janssen. A.H.Y. has received honoraria for speaking from AstraZeneca, Lundbeck, Eli Lilly, and Sunovion; honoraria for consulting from Allergan, Livanova and Lundbeck, Sunovion, and Janssen; and research grants from Janssen and Compass in the last 3 years.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) study flow diagram for updated reviews. Adapted from Stovold et al. [25].
Figure 2
Figure 2
Forest plot of reduction in depressive symptoms post-treatment, grouped by treatment type (adjunctive vs. stand-alone).
See this image and copyright information in PMC

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