Lactobacillus Rhamnosus in Pregnancy Significantly Reduces Postpartum Depression and Anxiety
Tori Hudson, ND
Author: Slykerman R, Hood F, Wickens K, et al.
Reference: Effect of Lactobacillus rhamnosus HN001 in pregnancy on postpartum symptoms of depression and anxiety: a randomized double-blind placebo-controlled trial. EBioMedicine 2017,https://doi.org/10,1016/j.ebiom.2017.09.013
Design: This is a two center randomized double-blind placebo-controlled trial which tested the effect of Lactobacillus rhamnosus in pregnant women and the development of atopic dermatitis in their infants as well as maternal depression and anxiety at 1–2 months postpartum.
A total of 423 women were recruited at 14-16 weeks gestation with 212 randomized to the Lactobacillus rhamnosus group and 211 to placebo. The study product or placebo was to be taken daily from enrollment until birth and from birth up till six months post-birth during breastfeeding.
Participants: Women were included if they were planning to breastfeed, and if they or the child’s father had a history of hay fever or eczema that required medication. In the end, 380 women completed the study (193 treatment group and 187 placebo).
Primary outcome: The primary outcome used the Edinburgh Postnatal Depression Scale (EPDS), which is a 10 item screening questionnaire frequently used to assess maternal mood. Those with a standard cut-off of >12 identified mothers at higher risk of postnatal depression. The State Trait Anxiety Inventory (STAI6) is a 6 item scale validated as an anxiety screening questionnaire.
Key findings: Women supplemented with probiotics had fewer symptoms of postpartum anxiety and depression.
According to the Centers for Disease Control, incidence of postpartum depression in the US is between 11-20%. Postpartum depression is a disorder that affects the mother’s ability to care for and bond with her new infant, as well as her functioning in day to day life. It can also produce long lasting consequences in children’s cognitive, social-emotional and physical health outcomes. The depression does not usually come alone, it is also associated with insomnia, fatigue, agitation, appetite problems, low self-esteem and anxiety. The anxiety often co-exists with the depression in the postpartum state. If breast feeding is occurring, it is even more important to explore prevention strategies as many women will not take pharmaceuticals while breast feeding as they may have adverse effects on the breast fed infant, and it can take several weeks for the therapeutic effect of pharmaceutical antidepressants to occur.
Commentary: There is a growing body of literature linking the gut microbiota to brain chemistry and thus mood and behavior. The list of pathways involved in a bi-directional microbiome-gut-brain axis are multiple and many health problems, including mental-emotional disorders are associated with altered gastrointestinal function and alterations in gut microbial make up. The findings of the current study are consistent with two previous clinical studies of the effects of probiotics on mood. One was a randomized clinical trial in a population of 40 individuals with major depressive disorder treated with Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium bifidum or placebo, which found a significant reduction in symptoms of depression in the probiotic group. Another study in 39 individuals with chronic fatigue and anxiety were randomized to Lactobacillus casei or placebo and found a reduction in anxiety, but not in depression. Not all studies have demonstrated a significant therapeutic effect of probiotics on mood, but larger studies are being done to better understand this gut flora-brain connection and it will be interesting to watch this unfold and to better understand the possibilities for both prevention and treatment. In time, we will also better understand what might be the most effective choice of probiotic species and strains, duration and dose.
 Akkasheh G, Kashani-Poor A, Tajabadi-Ebrahimi M, et al. Clinical and metabolic response to probiotic administration on patients with major depressive disorder: a randomized, double-blind placebo-controlled trial. Nutrition 2016;32:315-320.
 Rao A, Bested A, Beaulne T, et al. A randomized, double-blind, placebo-=controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome. Gut Pathog 2009;1(1):6