Fecal microbiota transplantation (FMT) was associated with better mental health outcomes for patients with Clostridioides difficile (CDI), according to a small Dutch observational study.
In a multivariate analysis that adjusted for gender, age, and history of depression, FMT was associated with improvements in self-rated health (chi-squared 22.88, P<0.001) and severity of depression (chi-square 15.09, P<0.001) at 4 weeks, which persisted for 26 weeks, report Erik Giltay, MD, PhD, of Leiden University Medical Center in the Netherlands, and colleagues.
“Detailed analyzes showed improvements in overeating or loss of appetite, loss of interest and pleasure in activities, feeling fatigued or lacking in energy, feeling depressed or hopeless, difficulty concentrating, difficulty sleeping, moving or speaking slowly or fast and feel tense or over,” the authors wrote in the Journal of Affective Disorder Reports.
However, they said that while depression severity improved on the Patient Health Questionnaire-9, they did not see a difference on the Hospital Anxiety and Depression Scale.
“As gastrointestinal symptoms improve and low-grade inflammation may play a role in the pathogenesis of somatic and behavioral symptoms of disease of depression in particular … effective treatment of recurrent CDI could explain the improvement in these symptoms,” they noted.
FMT is recommended for recurrent CDI unresponsive to antibiotic therapy, but data on its impact on mental health are still lacking. Case reports have suggested neurological improvements with FMT for patients with multiple sclerosis, Parkinson’s disease, and Tourette’s syndrome, as has a little test of FMT in patients with autism and gastrointestinal symptoms.
“Future research should answer the question of whether these effects are due to clinical recovery or mediated in part by changes in the gut microbiota on psychological well-being,” the authors noted.
For this study, Giltay and colleagues examined data from 49 adults who underwent FMT for recurrent CDI using fecal suspensions from physically and mentally healthy donors from May 2017 to February 2020. Of these patients, 34 completed short-term follow-up. at 4 weeks and long-term follow-up at 26 weeks. The other 15 completed short-term follow-up only (one patient discontinued due to severe illness, 12 for unknown reasons, and two died).
The patients had a mean age of 68 years and two-thirds were women. More than a third had a history of depression. Three were taking antidepressants at baseline and two were taking quetiapine. Of the 34 patients who completed the 26-week follow-up, 17.6% were hospitalized after FMT and 17.6% developed a new non-CDI infection.
Patients completed mental health questionnaires the day before the FMT and at both follow-up visits. FMT was performed by infusing 198 ml of donor fecal suspension through a nasoduodenal tube in 45 patients and a colonoscope in two patients. Both techniques were used in two patients who required multiple FMTs. Three patients received anti-CDI antibiotics.
At 4 weeks post-FMT, patients primarily reported mild symptoms of diarrhea (25%), abdominal pain (25%), constipation (23%), and nausea (15%). Defecation improved in 36% of patients, while 13% reported worsening of defecation, which was similar at 26 weeks.
At 2 months, the cure rate for a single FMT was 87.8%; six patients experienced a relapse of CDI. At 26 weeks, all who completed the study were cured.
Giltay and his team acknowledged some limitations of their study, including the small sample size and the lack of a control group. In addition, data related to a history of anxiety or other psychiatric disorders were not available.
Disclosures
Giltay and co-authors reported no conflicts of interest.
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