Stool transplantation could have a positive effect on mental illness. This is shown by a case study published in the journal Bipolar Disorders. In it, scientists from the University of New South Wales (UNSW Sydney) in Australia describe their observations. It has long been known that mental illness is associated with a microbiome in the gut. However, recent observations could represent a new therapeutic approach.
The case report describes the treatment of a 28-year-old man with a diagnosis of bipolar disorder. When researchers first examined him in 2014, he said he had suffered from severe anxiety since he was 10 years old. For researchers, he met the criteria for “generalized anxiety and panic disorder.”
Fecal transplantation as a way to fight mental illness
As part of the treatment, the man was given feces, after which his symptoms improved significantly. A year after the transplant, the patient said he no longer needed almost any medication and eventually stopped taking it completely after another four months.
The so-called “stool transplant” had a positive effect on the germ microbiome. Previously, a patient’s manic phases alternated with depressive phases treated with multiple drugs. However, according to scientists, the effect of the drugs was “unsatisfactory”. Hence the decision for a stool transplant.
Stool transplants have long been used in intestinal diseases to restore the intestinal flora. The stool of a healthy person, for example in the form of capsules, is transported to the patient’s intestines. The microorganisms contained in it then settle in the diseased intestine. Enema transplantation is also possible. Possible side effects of the transfer are still very rare if the stool transplant is under medical supervision. Theoretically, it is also possible to transmit pathogens, bacteria or viruses through the stool.
The researchers in the case study rule out a placebo effect
In terms of treatment success, the researchers noted that individual case studies always had “obvious and well-known risks”, such as the possibility of reacting to a placebo. In the case of observing a young man, the researchers describe, however, a placebo reaction can be ruled out. Because there would be only a short-term improvement with the placebo response. The strong improvement in symptoms for more than a year also surprised the scientist. In retrospect, they describe the stool transplant process as “extremely time consuming.” However, there are other approaches to improving the microbiome in the gut. In the Canadian study, subjects were fed a small dose daily, with stool samples taken at weeks 12 and 24.
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Previous experiments in stool transplantation with animals have already shown promising results. Rats fed the feces of depressed people also appear to have depressed. Something similar was also observed in mice that received stools from schizophrenic humans.
The so-called “intestinal brain” makes it possible. Humans have millions of nerve cells between the intestinal wall and the muscle layers. The mediators serotonin and dopamine are also produced here. They are transmitted to the brain via the vagus nerve. With an altered microbiome, such as mental illness, it is possible that the intestinal mucosa will be damaged. This can cause inflammation. As a result, for example, the hormones of happiness can no longer be transmitted to the brain without interference. If the microbiome stabilizes during transplantation, disruption would be reversed. However, research in this regard is still in its infancy. It is not clear when a stool transplant can be used to treat mental illness. The verdict of the study from Australia is similar.
Further studies are needed
“Although our patient’s bipolar disorder was very serious, he was able to attend college, work part-time, travel abroad, and have partners and close relationships,” the study writer wrote. For a small percentage of people with bipolar disorder who do not respond to multiple drugs and are therefore at high risk of suicide because the side effects of many drugs can shorten their lives, they believe that stool transplants may make sense. Many other clinical trials are needed.
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