Probiotics as adjuvant therapy with selective serotonin reuptake inhibitors vs placebo to treat major depressive disorder: a meta-analysis of randomized controlled trials
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Abstract
Introduction: Despite improvement in antidepressant treatment, half of the major depressive disorder (MDD) patients fail to achieve remission. Increasing evidence suggests the role of modulating the microbiome-gut-brain axis through probiotics in mental health therapy. We aimed to compare the efficacy and safety of probiotics as adjuvant therapy with antidepressants compared to placebo in patients with MDD.
Methods: This study was conducted according to the PRISMA for systematic reviews and meta-analyses guidelines. A systematic literature search was performed in databases including PubMed, Cochrane, EBSCOHost, CINAHL, Scopus, and Google Scholar. The quality of studies was evaluated using Cochrane Risk of Bias 2.0 tools. We performed a meta-analysis using Review Manager v5.4.
Results: Our study included 5 randomized controlled trials with a total of 369 participants. Statistical analysis showed that the pooled standardized mean difference among studies was favourable to the probiotics group (-0.43; 95%CI: -0.71, -0.14) with statistically significant results (p=0.003). Gut microbiota dysbiosis plays a role in the pathogenesis of depression through inflammation and modulation of the hypothalamus-pituitary axis. Probiotics modulate gut microbiota by reducing inflammation and improving the intestinal barrier. In addition, probiotics also improve the metabolism of tryptophan to serotonin and reduce kynurenine accumulation, which is also implicated in depression pathogenesis.
Conclusion: In conclusion, probiotics are beneficial for patients with MDD as an adjuvant to antidepressant drugs.
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