Study: Can Adjusting Gut Bacteria Impact Emotions?

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

An increasing number of studies show that the bacteria in our gut (probiotics) may have an impact on our emotions, depression, anxiety, and other conditions (1,2).

A review of 1,089 abstracts and 183 articles; suggested that probiotics may have a role in anxiety, bipolar disorder, schizophrenia, obesity, and autism (1).

A recent small study had intriguing findings (3).

What did the study involve?

  • 40 individuals with a diagnosis of Major depression.
  • Ages ranged between 20 and 55 years old.
  • Randomized, double-blind, placebo-controlled clinical trial.

What probiotics were given?

  • Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium bifidum

What were some of the results?

  • After 8 weeks, subjects getting probiotic supplements were slightly less depressed on the Beck Depression inventory scale (5.7 +/- 6.4 vs. 1.5 +/- 4.8, P<0.001) compared with the placebo.

There were also decreases in:

  • Insulin levels and insulin resistance
  • High sensitivity C-Reactive protein (a marker for inflammation)

How can gut bacteria impact your brain health?

Some theories include (1,2,4 ) an impact on:

  • Hormones
  • Serotonin (a brain transmitter, particularly involved in depression and anxiety)
  • Immune/inflammatory system

What are some causes of an imbalance of gut bacteria?

  • Unhealthy consumption of processed grains, unhealthy fats, sugars, refined carbohydrates, junk foods, etc. (1,2,4)
  • Certain antibiotics

Is it possible to improve health/balance of my gut bacteria?

Certain foods may  help the good bacteria (a balance of proteins (lean meats, eggs, seafood, etc) , healthy fats, vegetables, and whole unprocessed grains)

Certain foods contain pro-biotics:

  • Sauerkraut with live cultures
  • Kimchi
  • Unsweetened yogurt (natural artificial and added sugars may negate benefits)
  • Probiotic supplements

What are some caveats?

  • Taking probiotics is NOT safe for everyone and you should check with your doctor first (5).
  • There are many studies linking probiotics to brain health, and this is a small study with a small effect size.
  • Further study is needed.
  • The exact type, amount, and duration of probiotics for emotional health has not been established.
  • While further research is needed, it has been established that unhealthy eating habits can impact emotional health.
  • According to NCCIH, “The people who are most at risk of severe side effects from probiotics include critically ill patients, those who have had surgery, very sick infants, and people with weakened immune systems” (5)

How are you feeling? Could you feel better by eating healthy foods and reducing/avoiding unhealthy foods? How do you know?

What are some resources to improve nutrition?

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. G. Fond et al. The ‘‘psychomicrobiotic’’: Targeting microbiota in major psychiatric disorders: A systematic review/ Pathologie Biologie 63 (2015) 35–42.
  2. Luna RA, Foster JA. Gut brain axis: diet microbiota interactions and implications for modulation of anxiety and depression. Current Opinion in Biotechnology 2015, 32:35–41.
  3. Akkasheh G, et. al. Clinical and metabolic response to probiotic administration in patients with major depressive disorder: A randomized, double-blind, placebo-controlled trial. Nutrition (2015) 1-6.
  4. Wang Y, Kasper LH. The role of microbiome in central nervous system disorders. The role of microbiome in central nervous system disorders.
  5. National Center for Complimentary and Integrative Health.  https://nccih.nih.gov/health/probiotics/introduction.htm

Study: Could light therapy help with non-seasonal depression?

By R. Ryan Patel DO, FAPA OSU-CCS PsychiatristLight 1

For some students, winter can be a difficult time of year. Many people know about seasonal affective disorder (SAD), which is depressive symptoms that occur often during winter months (1,2,3). Treatments for SAD can include a combination of light therapy, counseling, healthy lifestyle habits, and medications (3).

A recent study (4) shows that light therapy can also help with a more common form of depression, major depressive disorder, a form of depression that is NOT seasonal.

What was the study design?

  • 122 individuals ages 19-60 were randomized to 4 different groups,
  • Light monotherapy of 10 000-lux fluorescent white lightbox for 30 min/d in early morning plus placebo pill (n=32)
  • Medication monotherapy of a prescription antidepressant medication, Fluoxetine 20mg per day, (n=31);
  • Combination of medication and light therapy, (n=29);
  • Placebo, (n=30).
  • Study lasted for 8 weeks, using randomized, double-blind, placebo- and sham-controlled study design.

Who was studied?

  • Average age of the 122 participants was 19-60 years
  • They had a diagnosis of Major depressive disorder in outpatient psychiatry clinics in academic medical centers.
  • Results were measured by changes in MADRS score (a validated scale to measure depressive symptoms).

What were the study results?

For each group response rates (improvement in symptoms) were:

  • Placebo 33%
  • 20mg fluoxetine, alone 29%
  • Light therapy 50%
  • Combination of light therapy and medication, 75.9%

The study authors reported that all treatments were well tolerated, with few major differences in side effects.

What are some caveats?

  • For various reasons, light therapy and fluoxetine are NOT suitable for every one (check with your prescriber).
  • Combination of medication with light treatment was more effective than each group alone.
  • In practice, we often see medications work better if the patient is also involved in non medication treatments like counseling and healthy lifestyle habits. Often, the most effective treatment is some combination of biological, psychological and social treatments.
  • Study participants were diagnosed by undergoing a psychiatric evaluation, which is not always available to everyone.
  • The maximum dose of fluoxetine is 60mg but this study only used a 20mg dose which could have impacted results.
  • Finally, we can prescribe many different antidepressant medications, and a single dose of 1 antidepressant cannot be generalized to all combinations/doses of other antidepressant medications.

What are other treatments for depression?

  • Eat a healthy balanced diet of protein/veggies/fruit/whole grains, Omega 3’s
  • Don’t isolate from family, friends, or colleagues and get involved on campus
  • Counseling
  • Talk to your doctor about various treatment options such light therapy, medication, etc.
  • A well balanced exercise program (check with your doctor first)

What are some of OSU’s campus resources that might help with reducing depression?

Are there any other helpful resources?

  • DBSA (Depression and Bipolar Support Alliance)
  • NAMI (National Alliance for Mental Illness)
  • NIMH (National Institute of Mental Health)

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References

1. http://www.nlm.nih.gov/medlineplus/seasonalaffectivedisorder.html

2. Magnusson A. An overview of epidemiological studies on seasonal affective disorder. Acta Psychiatr Scand 2000; 101:176.

3. Uptodate.com Seasonal Affective disorder. Accessed 01/2016.

4. Lam JAMA Psychiatry. 2016 Jan 1;73(1):56-63RW, et al.  Efficacy of Bright Light Treatment, Fluoxetine, and the Combination in Patients With Nonseasonal Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2016 Jan 1;73(1):56-63.

 

Could Vitamin D boost your Mood and Energy?

By R. Ryan Patel DO, FAPA OSU-CCS Psychiatrist
Many students may be aware of Vitamin D and with decreasing sunlight, many might not be getting enough vitamin D.
• Initially thought of as a vitamin, it is now believed that it works more like a hormone and has many functions throughout the body.
• Inadequate vitamin D has been implicated in fibromyalgia (1), sleep (2,3), athletic performance (4), energy levels (5) as well as bone disease (7).
• A recent study had discussed findings regarding vitamin d and depression.

What did this study involve?
• 40 patients between 18 and 65 y of age with Major Depressive disorder.
• Randomly assigned to get either a single capsule of 50 kIU vitamin D per week (n = 20) or placebo (n = 20) for 8 weeks.
• This was a randomized, double-blind, placebo-controlled clinical trial.

What did the authors analyze?
• Fasting blood samples before and after.
• The primary [Beck Depression Inventory (BDI), which examines depressive symptoms].
• Secondary outcomes such as glucose homeostasis variables, lipid profiles, hs-CRP, and biomarkers of oxidative stress.
What did the study show?
• After 8 weeks of treatment with vitamin D, depression scores improved in the patients receiving vitamin D supplementation.
• The improvement was also related to improvement in vitamin d levels.
How can I get vitamin D tested?
• There is a blood test for vitamin D, which can be ordered by your prescriber.

Can I get vitamin D from food?
According to the National Institute of Health (NIH) (7),
• “Very few foods naturally have vitamin D. Fortified foods provide most of the vitamin D in American diets.
• Fatty fish such as salmon, tuna, and mackerel are among the best sources.
• Beef liver, cheese, and egg yolks provide small amounts.
• Mushrooms provide some vitamin D. In some mushrooms that are newly available in stores, the vitamin D content is being boosted by exposing these mushrooms to ultraviolet light.
• Almost all of the U.S. milk supply is fortified with 400 IU of vitamin D per quart. But foods made from milk, like cheese and ice cream, are usually not fortified.
• Vitamin D is added to many breakfast cereals and to some brands of orange juice, yogurt, margarine, and soy beverages; check the labels.”

Is too much Vitamin D harmful?
Too much vitamin D can be harmful.

According to the NIH (7):
“Signs of toxicity include nausea, vomiting, poor appetite, constipation, weakness, and weight loss. And by raising blood levels of calcium, too much vitamin D can cause confusion, disorientation, and problems with heart rhythm. Excess vitamin D can also damage the kidneys.”

What is the main cause of too much Vitamin D?

• Vitamin D toxicity almost always occurs from overuse of supplements (7).
• Excessive sun exposure doesn’t cause vitamin D poisoning because the body limits the amount of this vitamin it produces (7).

What are some caveats?

• To avoid the risk of harm, taking Vitamin D supplements should be done under the supervision of your prescriber/doctor.
• This is the 1st study showing benefits on depression with high dose weekly Vitamin D supplementation.
• Further studies are needed.
• Some previous studies showed mixed results though under-dosing and other factors may have been involved (6).
• Vitamin D has shown benefits in some studies and in clinical experience in psychiatry for select patients.
• Benefits on vitamin D may extend beyond mood.
• Treatment with vitamin D with supplement or prescription may NOT be suitable for everyone, but it may be worth discussing with your prescriber.

Is your mood, energy level, etc impacted by low vitamin D? Could replacement benefit you? Check with your health care provider if treatment is appropriate for you.
What are some resources regarding Vitamin D?

https://ods.od.nih.gov/factsheets/VitaminD-Consumer/
Counseling and Consultation Service
Wilce Student health center

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.
References

1. Jesus CA, Feder D, Peres MF. The role of Vitamin D in pathophysiology and treatment of fibromyalgia. Curr Pain Headache Rep. 2013 Aug;17(8):355.
2. Bertisch SM, et al. 25-Hydroxyvitamin D Concentration and Sleep Duration and Continuity: Multi-Ethnic Study of Atherosclerosis. Sleep. 2015 Aug 1;38(8):1305-11
3. McCarty DE, et al. The link between vitamin D metabolism and sleep medicine. Sleep Med Rev. 2014 Aug;18(4):311-9. Epub 2013 Sep 26.
4. B Hamilton. Vitamin D and Human Skeletal Muscle. Scand J Med Sci Sports. 2010 Apr; 20(2): 182–190.
5. Al–Dujaili E, Revuelta Iniesta R. http://www.eurekalert.org/pub_releases/2015-11/sfe-vdp102915.php Preliminary study presented Fall 2015 at the Society for Endocrinology Annual Conference in Edinburgh.
6. Sepehrmanesh Z, et al. Vitamin D Supplementation Affects the Beck Depression Inventory, Insulin Resistance, and Biomarkers of Oxidative Stress in Patients with Major Depressive Disorder: A Randomized, Controlled Clinical Trial. J Nutr. 2015 Nov 25. pii: jn218883. [Epub ahead of print].
7. https://ods.od.nih.gov/factsheets/VitaminD-Consumer/