Asad Afrida, Kirk Megan, Zhu Sufen, Dong Xue, Gao Min
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom.
Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom.
Nutr Rev. 2024 Dec 28. doi: 10.1093/nutrit/nuae177.
The use of prebiotics and probiotics as a treatment for psychiatric conditions has gained interest due to their potential to modulate the gut-brain axis. This review aims to assess the effectiveness of these interventions in reducing symptoms of depression and anxiety in psychiatric populations.
The aim was to comprehensively review and appraise the effectiveness of prebiotic, probiotic, and synbiotic interventions in reducing clinical depression and anxiety symptoms.
Systematic searches were conducted across Embase, Medline, PsycINFO, CINAHL, Cochrane Library, and Science Citation Index from database inception to May 22, 2023.
Randomized controlled trials investigating prebiotic, probiotic, or synbiotic interventions for treating clinical depression or anxiety symptoms in clinical samples were included. Data were extracted on study characteristics, intervention details, and outcome measures. The Cochrane Collaboration Tool was used to assess the risk of bias.
The standardized mean difference (SMD) was calculated using Hedge's g as the metric of effect size. A random-effects model was applied to estimate pooled effect sizes with 95% CIs. Subgroup analyses were performed based on study characteristics, methodological factors, and intervention types. Sensitivity analyses excluded studies with a high risk of bias.
Twenty-three RCTs involving 1401 patients met the inclusion criteria, with 20 trials providing sufficient data for meta-analysis. Of these, 18 trials investigated probiotics for depression, 9 trials assessed probiotics for anxiety, and 3 trials examined prebiotics for depression. Probiotics demonstrated a significant reduction in depression symptoms (SMD: -0.96; 95% CI: -1.31, -0.61) and a moderate reduction in anxiety symptoms (SMD: -0.59; 95% CI: -0.98, -0.19). Prebiotics did not show a significant effect on depression (SMD: -0.28; 95% CI: -0.61, 0.04). High heterogeneity was observed across studies, and subgroup analyses indicated that study duration and probiotic formulations contributed to the variation in effect sizes.
Probiotics showed substantial reductions in depression symptoms and moderate reductions in anxiety symptoms. Prebiotics showed a nonsignificant trend toward reducing depression. An adjunctive mental health treatment approach that diagnoses, monitors, and treats the gut microbiome alongside traditional pharmacological treatment holds promise for clinical practice.
PROSPERO registration no. CRD42023424136.
由于益生元和益生菌有调节肠-脑轴的潜力，将其用于治疗精神疾病已引起关注。本综述旨在评估这些干预措施在减轻精神疾病患者抑郁和焦虑症状方面的有效性。
全面回顾和评估益生元、益生菌及合生元干预措施在减轻临床抑郁和焦虑症状方面的有效性。
从数据库建立至2023年5月22日，在Embase、Medline、PsycINFO、CINAHL、Cochrane图书馆和科学引文索引中进行了系统检索。
纳入了调查益生元、益生菌或合生元干预措施用于治疗临床样本中临床抑郁或焦虑症状的随机对照试验。提取了关于研究特征、干预细节和结局指标的数据。使用Cochrane协作工具评估偏倚风险。
使用Hedge's g作为效应量指标计算标准化均数差（SMD）。应用随机效应模型估计合并效应量及95%置信区间。基于研究特征、方法学因素和干预类型进行亚组分析。敏感性分析排除了偏倚风险高的研究。
23项涉及1401例患者的随机对照试验符合纳入标准，20项试验提供了足够的数据用于荟萃分析。其中，18项试验研究了益生菌治疗抑郁症，9项试验评估了益生菌治疗焦虑症，3项试验研究了益生元治疗抑郁症。益生菌显著减轻了抑郁症状（SMD：-0.96；95%置信区间：-1.31，-0.61），并中度减轻了焦虑症状（SMD：-0.59；95%置信区间：-0.98，-0.19）。益生元对抑郁症未显示出显著效果（SMD：-0.28；95%置信区间：-0.61，0.04）。各研究间观察到高度异质性，亚组分析表明研究持续时间和益生菌制剂导致了效应量的差异。
益生菌显著减轻了抑郁症状，中度减轻了焦虑症状。益生元在减轻抑郁方面显示出不显著的趋势。一种在传统药物治疗的同时诊断、监测和治疗肠道微生物群的辅助心理健康治疗方法在临床实践中有前景。
PROSPERO注册号CRD42023424136。
