Potential clinical benefits of probiotics, prebiotics, synbiotics, and postbiotics for depression via the microbiota-gut-brain axis

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BACKGROUND Depression is a common mental-health disorder worldwide. Several studies have demonstrated the effects of gut microbiota-targeting interventions, such as probiotics, prebiotics, synbiotics, and postbiotics (PPSP), on depression. AIM To assess the potential benefits of PPSP on patients diagnosed with depressive disorder. METHODS A literature search of the PubMed, Web of Science, and Elsevier Science Direct databases for relevant studies published from database inception to March 2024 was performed. Studies that used a randomized controlled trial design and evaluated differences in depression between PPSP and placebo were included. Depressive symptoms were assessed using a validated scale. Analysis was performed using Review Manager version 5.4 (The Cochrane Collaboration, 2020). RESULTS Fourteen studies comprising 906 patients with depressive symptoms were included. PPSP improved depression compared with placebo [SMD: -0.39 (95%CI: -0.60 to -0.17); P < 0.001]. PPSP resulted in significant reductions in Hamilton Depression Rating Scale [MD: -1.72 (95%CI: -2.57 to -0.88); P < 0.001] and Beck Depression Inventory [MD: -2.69 (95%CI: -4.67 to -0.71); P < 0.001] scores. Sub-analysis confirmed the antidepressant effects of probiotics on depressive symptoms [SMD: -0.32 (95%CI: -0.48 to -0.16); P < 0.001], with prebiotics exerting no apparent effect [SMD: -0.08 (95%CI: -0.39 to -0.23); P = 0.62], and synbiotics exerting statistically significant benefits [SMD: -1.09 (95%CI: -1.45 to -0.73); P < 0.001]. CONCLUSION PPSP effectively alleviates depressive symptoms, and subgroup analysis supports the benefits of probiotics and synbiotics. Nevertheless, evidence supporting the use of PPSP for the treatment of depression remains insufficient.

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