Antibiotics and depression: unpacking the science (and fact-checking!) those recent misleading claims by The Happy Pear.
TL:DR? You can check out a great quick read summarising the current controversy with expert input and minimal science here from The Independent.
Firstly: How are we even here – again? After the Happy Pear made misleading comments about the modifiable risk factors in breast cancer, they promised this wouldn’t happen again. Except then it did. Interestingly, almost exactly a year later. An accident? Except that again: they are mentioned in every radio segment, newspaper, and this morning, they are trending on Twitter. Wellness woo is good marketing. Controversy is good marketing. Unpopular opinion: It is still, however, irresponsible when you have huge numbers of followers.
If you follow me, you know that I have a couple of guidelines I suggest when taking online health advice:
What are their real-life credentials? The Happy Pear cook food. They are not dietitians. They are not medics. Ability to market themselves and cook delicious food does not translate into other qualificiations.
What are they selling? Influencers may not be your best source of medical or health advice if they are incentivized to promote a product or share anything that generates clicks, shares, likes, comments and increased brand awareness.
Okay, I need the bottom line: Do antibiotics cause depression?
Short answer: The gut microbiome is a fascinating area of emerging research and almost all experts will agree that gut health does link in with mental health. But saying there is direct link between antibiotics and depression requires not only some context, but also further research.
It is a BIG (and incorrect leap) to jump to the idea that all antibiotics disrupt microbiome and therefore this can cause depression. While there have been papers published exploring this idea or suggesting a link, that evidence just isn’t that clear yet. And it’s unlikely to be that straightforward. Let’s break down 3 things to consider:
Did you know? It is often forgotten that the first antidepressant discovered was actually an antibiotic. Isoniazid is an antibacterial drug from 1950s for treating TB. A doc treating patients realised they had better sleep, mood, and appetite. Later trials confirmed antidepressant effect, and let to the ‘monoamine hypothesis of depression’, which is still widely researched. From there, several classes of antidepressant medications were developed, including tricyclic antidepressants (TCAs) and currently widely-used serotonin‐specific reuptake inhibitors (SSRIs). Interestingly, some studies indicate that newer antidepressants, for example, the SSRI, fluoxetine, have antibiotic activity in certain circumstances. And their role in post-viral syndromes is currently an area of post-Covid research.
The role of infection: If you get an antibiotic, you have an infection that needs to be treated. And that’s important in this discussion. In that: is any observed depression really from the antibiotic — or is it from the depression from the infection the antibiotic was treating? Why? Post infectious (means after an infection or virus) anxiety and depression were recognised prior to Covid-19. A few studies had noticed connections between anxiety and depression and viral diseases such as influenza A (H1N1) and other influenza viruses, varicella-zoster virus (chickenpox0 , herpes simplex virus, HIV/AIDS, and hepatitis C. This area of research is receiving new and intense focus in post-covid patients.
Lastly, and this cannot be over-stated: antibiotics are among the most important inventions of the 20th century; Human life-expectancy jumped by 8 years after antibiotics became available. If we have people afraid to take antibiotics, in short, this is not good. We already struggle with antimicrobial stewardship. Issues connected to this include over-prescribing of antibiotics for viral illness (classically by online doctor services) on one side. The second is hesitancy to use antibiotics for full dose or full prescribed course which can lead to antibiotic resistance. Third is delay in antibiotics when then are necessary to prevent critical illness, such as in Strep in children.
Wait, back to the beginning, so what is the connection between gut microbiome and mental health?
TL:DR: It’s a real thing but it’s complicated and we don’t understand it completely — but influencers and supplement companies are really hyping it up for marketing.
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