Elsevier

Journal of Affective Disorders

Volume 264, 1 March 2020, Pages 98-106
Journal of Affective Disorders

Research paper
The gut microbiota is associated with psychiatric symptom severity and treatment outcome among individuals with serious mental illness

https://doi.org/10.1016/j.jad.2019.12.020Get rights and content

Highlights

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    Depression and anxiety among psychiatric inpatients were negatively associated with richness, alpha diversity, and specific bacterial taxa.

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    Microbiota richness, alpha diversity, and bacterial taxa early in the hospitalization were associated with depression remission at discharge.

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    Coprococcus catus may be a significant contributor to the association between the gut microbiota and psychiatric functioning.

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    A large psychiatric sample from a controlled environment and accounting for confounding variables are clear strengths of the current study.

Abstract

Background

Emerging evidence implicates the gut microbiota in central nervous system functioning via its effects on inflammation, the hypothalamic-pituitary axis, and/or neurotransmission. Our understanding of the cellular underpinnings of the brain-gut relationship is based almost exclusively on animal models with some small-scale human studies. This study examined the relationship between the gut microbiota and psychiatric symptom severity and treatment response among inpatients with serious mental illness.

Method

We collected data from adult inpatients (N = 111). Measures of diagnoses, suicide severity, trauma, depression, and anxiety were collected shortly after admission, while self-collected fecal swabs were collected early in the course of hospitalization and processed using 16S rRNA gene sequencing and whole genome shotgun sequencing methods.

Results

Results indicate that depression and anxiety severity shortly after admission were negatively associated with bacterial richness and alpha diversity. Additional analyses revealed a number of bacterial taxa associated with depression and anxiety severity. Gut microbiota richness and alpha diversity early in the course of hospitalization was a significant predictor of depression remission at discharge.

Conclusions

This study is among the first to demonstrate a gut microbiota relationship with symptom severity among psychiatric inpatients as well as a relationship to remission of depression post-treatment. These findings are consistent with animal models and limited human studies as well as with the broader literature implicating inflammation in the pathophysiology of depression. These findings offer the foundation for further studies of novel therapeutic approaches to the treatment, prevention of, or recurrence of serious mental illness.

Section snippets

Background

There is an emerging consensus that the gut microbiota plays an essential role in central nervous system (CNS) functioning via its effects on inflammation, the hypothalamic-pituitary axis (HPA), and/or neurotransmission (Rea et al., 2016). This relationship is likely bi-directional with the CNS influencing motor, sensory and secretory modalities, with visceral messages from the gut influencing brain function. However, our understanding of the cellular underpinnings of the brain-gut relationship

Participants & setting

Between January 1, 2015 and December 31, 2016, one hundred eleven (N = =111) adult psychiatric inpatients at a private, not-for-profit facility in the Southwestern United States provided clinical data and fecal samples. Patients at the hospital received individualized psychiatric and medical care over an extended length of stay (average length of stay = 49.7 ± 14.5 days). Psychiatric care included a personalized combination of: comprehensive medical evaluation; psychotropic medication

Patient characteristics

The final study sample (54% female), consisted of relatively young Caucasian adults. The majority were never-married, unemployed at the time of admission, and with significant trauma histories. They presented with multiple Axis I disorders (46.4% meeting criteria for a comorbid personality disorder) with high levels of functional impairment, and service utilization consistent with current definitions of SMI (Kessler et al., 2010). Suicidal ideation and attempts were common. Study participants

Discussion

This study is among the first to explore the relationship between gut microbiota and psychiatric symptom severity in a relatively large, heterogeneous inpatient psychiatric sample. Consistent with the nascent literature using clinical samples (Jiang et al., 2015, Cheung et al., 2019), decreased gut biodiversity was associated with increased psychiatric symptom severity – with the phyla Firmicutes and Actinobacteria differentiating among psychiatric symptom strata. One of the most notable

Author statement

The funding sources had no role in the design of this study and did not have any role during its execution, analyses, interpretation of the data, or decision to submit results. Thus, the authors were independent from funding sources in the context of the research.

Declaration of Competing Interest

This research was partially supported by the Houston Methodist Foundation, The Sam Field Foundation, The Menninger Clinic Foundation, McNair Medical Institute, and Baylor College of Medicine's Alkek Center for Metagenomics and Microbiome Research. Dr. Madan is the John S. Dunn Foundation Distinguished Centennial Clinical Academic Scholar in Behavioral Health at Houston Methodist Hospital. Dr. Weinstein is the C. James and Carole Walter Looke Presidential Distinguished Centennial Clinical

Acknowledgements

This research was partially supported by the Houston Methodist Foundation, The Sam Field Foundation, The Menninger Clinic Foundation, McNair Medical Institute, and Baylor College of Medicine’s Alkek Center for Metagenomics and Microbiome Research. Dr. Madan is the John S. Dunn Foundation Distinguished Centennial Clinical Academic Scholar in Behavioral Health at Houston Methodist Hospital. At the time of data collection Drs. Madan, Fowler, Frueh, and Weinstein were affiliated with the Menninger

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