Treating Psychiatric Disorders with Fecal Microbiota Transplant

Maybe it’s me who’s weird (ok – it’s definitely me who’s weird!), but unlike many people it seems, I don’t find the idea of the organisms of the biome, including worms (helminths), repulsive, nor do I think fecal microbiota transplant (FMT) is disgusting…as someone commented this week on the Biome Buzz Facebook page.  I’m talking about the latter today because I just finished reading a review article looking at its use in treating psychiatric disorders.  As I read, all I could think was: if this can treat depression, anxiety disorders, autism, metabolic disorders, Parkinson’s, multiple sclerosis,  anorexia, etc., all of which are often refractory to treatment – or completely untreatable right now – then people need to get over it.  It’s not like you’re being served a big piece of poop on a plate.  For the most part, FMT is done via endoscopy, enema, colonoscopy and these days, orally (in the form of what this article calls Microbial Ecosystem Therapeutis-2 (which is gut bacteria isolated from a healthy donor and purified and lab grown, and made into an oral probiotic product)).  Sorry but…I just cannot understand the visceral reaction to something that has so much promise to alleviate so much suffering.

So a few key points from today’s article:

These scientists conducted a comprehensive literature search and isolated 28 studies which evaluated the effect of FMT on various psychiatric an physical symptoms.[i]  11 of these were animal studies, 9 were preclinical (animal) subjects with transplanted microbiota from humans, and 8 were exclusively human samples.  Most studied symptoms were irritable bowel syndrome, chronic stress, depressive symptoms.  A few highlights:

1. Here’s something I never read before.  In a preclinical study on rodents:  donor mice were given increasing amount of alcohol for 2 weeks, and their fecal microbiomes were then transplanted into healthy mice:  “The transplantation resulted in depressive behavior in the recipient mice.”
2. In fact, the paper goes on to report that “…alcoholism is highly comorbid with mood and anxiety disorders…In the studies investigating the effect of FMT on depressive and anxiety-like behaviors related to alcoholism, Zhao et. al found that transplants from patients with alcoholism to GF [germ-free] mice resulted in depression and anxiety-like behaviors…”  I wonder how much FMT might help alcoholism in general. ???
3. The article reviews studies I have discussed before – for example, here. In one discussed in this paper, healthy human donor microbiomes were transplanted to mouse models for autism.  The mice were given either original pooled human microbiomes or cultured–in-a-lab bacteria from these pooled microbiomes.  Both results in positive results in the mice, although the non-cultured microbiome mice did better.
4. Human clinical studies:  6 studies dealt with depressive symptoms, 4 assessed anxiety symptoms, one assessed neuroticism,  2 looked at quality of life in relation to IBS, and 1 looked at fatigue. RE:  depression: “All of these studies found a significant short-term improvement in depression symptoms.”  The long term effects were less consistent.  Anxiety:  3 of the 4 studies found a significant improvement.  However, again, after a number of months some of them found a return of symptoms.  Neuroticism:  a significant decrease in symptoms; IBS:  significant improvement; fatigue:  significant improvement.  After 6 months or so though, the improvements in all were seen to wane.

The authors conclude:  “There is a great need for new therapeutic targets and treatments in order to provide options and better help individuals suffering from these psychiatric illnesses.  When considering the findings demonstrated in this review, FMT appears to be a promising candidate for this.”

As the parent of a son diagnosed with autism who suffers from extreme anxiety and panic attacks almost daily (as do many of the individuals I teach who have autism), I am more than anxious for a reliable and non-invasive FMT product to become available.  If you remember me talking about the Jim Adams studies on the topic awhile back (look at the link above as well as here)…well, as far as I’m concerned, that product cannot hit the market soon enough.

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[i] Chinna Meyyappan A, Forth E, Wallace CJK, Milev R. Effect of fecal microbiota transplant on symptoms of psychiatric disorders: a systematic review. BMC Psychiatry. 2020;20(1):299. Published 2020 Jun 15. doi:10.1186/s12888-020-02654-5