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Microbiota-Targeted Therapies for Adults with Major Depressive Disorder Compared with Antidepressants: A Systematic Review and Network Meta-Analysis
24 Pages Posted: 10 May 2023
More...Abstract
Background: Despite recent advances in antidepressants in treating major depression (MDD), their usage is marred by adverse effects and social stigmas. Probiotics may be an efficacious adjunct or standalone treatment, potentially circumventing the aforementioned issues with antidepressants. However, there is a lack of head-to-head clinical trials between these two interventions. As such, we aim to compare the efficacy and acceptability of these two interventions in treating MDD.
Methods: We searched six e-databases for double-blinded, randomized controlled trials published between 2015 and 2022. We included placebo-controlled trials of antidepressants and microbiota-targeted interventions used for the treatment of MDD adults (≥18 years old). Standardized mean difference (SMD) of depressive symptom scores from individual trials were pooled for network meta-analysis (PROSPERO No. CRD42020222305).
Findings: Forty-two eligible trials covering 22 interventions were identified, of which 16 were found to be effective in MDD treatment and the certainty of evidence was moderate to very low. Compared to placebo, SMDs ranged from -0.16 (95% credible interval [CrI] -0.30 to -0.04) for venlafaxine and -0.81 (-1.06 to -0.52) for escitalopram. Probiotics administered with antidepressants were found to be more effective than both placebo and venlafaxine alone in reducing MDD symptoms (SMD, 95% CrI: -0.59, -0.82 to -0.34 and -0.41, -0.70 to -0.14, respectively). Long-term treatment (≥8 weeks) using probiotics showed the same tolerability as antidepressants. In addition, probiotics ranked the second highest in the treatment hierarchy after escitalopram.
Interpretation: Probiotics, compared with antidepressants and placebo, may be efficacious as an adjunct or standalone therapy for treating MDD.
Funding: This study was funded by the Health and Medical Research Fund of the Food and Health Bureau (Ref. No.: CFS-HKU2), the Government of the Hong Kong SAR.
Declaration of Interest: The authors declare no competing interests.
Keywords: comparative efficacy, microbiota-targeted therapies, probiotics, antidepressants, major depressive disorder, network meta-analysis
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