Probiotics for adults with major depressive disorder compared with antidepressants: a systematic review and network meta-analysis
Zhao X, et al
Published in Nutrition Reviews
Methodology
Systematic review and Bayesian network meta-analysis (PROSPERO CRD42020222305) of six databases and trial registries for double-blind randomised placebo-controlled trials published 2015-2022 of antidepressants and microbiota-targeted interventions (prebiotics, probiotics, synbiotics) in adults with major depressive disorder; standardised mean differences in depressive symptom scores pooled with treatment hierarchy ranking.
Key Findings
This network meta-analysis of 42 double-blind randomised trials published 2015-2022 compared 22 interventions for major depressive disorder, of which 16 were effective, with certainty of evidence rated moderate to very low. Effect sizes versus placebo ranged from -0.16 (95% credible interval -0.30 to -0.04) for venlafaxine to -0.81 (-1.06 to -0.52) for escitalopram. Probiotics outperformed placebo (SMD -0.62, -0.86 to -0.42) and several antidepressants including venlafaxine (-0.47), duloxetine (-0.26), citalopram (-0.37) and vortioxetine (-0.39), and were non-inferior to the rest, ranking second overall behind escitalopram. Treatment of 8 weeks or longer with probiotics showed tolerability equal to antidepressants.
Conclusions
Probiotics, compared with antidepressants and placebo, may be efficacious as an adjunct or standalone therapy for treating MDD.
Limitations
No head-to-head trials of probiotics against antidepressants exist, so these comparisons are indirect and inferred through the network; certainty of evidence ranged down to very low, and probiotic trials are typically smaller and shorter than antidepressant trials.
Supplements Studied
Probiotics, compared with antidepressants and placebo, may be efficacious as an adjunct or standalone therapy for treating MDD.
Related Health Concerns
Study Details
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