Faecal microbiota transplantation (FMT) has a lengthy history dating back to the fourth century AD in China, where it was used to treat conditions such as diarrhea and food poisoning.
Its contemporary salience reflects awareness that the gastrointestinal tract is an ecosystem of bacteria and other microorganisms (i.e., the gut microbiome) which, either by themselves or when ‘disrupted’ (by an antibiotic for example), may result in a range of conditions or symptoms.
The use of fecal microbiota is designed to restore healthy microorganisms via donor stools. One of the most established applications is in the management of Clostridium difficile infection, but there are numerous case reports arguing that there are many more health benefits for both gastrointestinal conditions, like ulcerative colitis, and for neurological conditions.
In a recently published study in the journal Bipolar disorders, researchers reported a case of bipolar disorder treated with FMT and the changes in behavior that they observed.
The use of FMT has been considered for the management of mood disorders in different studies due to the results shown in animal studies, such as changes in depression-like behaviors, and also based on that there have been studies reporting differences in human gut microbiota between those with depression and controls.
The study reports a subject of 28 years of age, male with bipolar disorder from Sydney, Australia. At initial assessment by the first author in 2014, the subject first detailed severe anxiety present from the age of 10, meeting the criteria for generalized anxiety and panic disorder. The panic attacks impaired his capacity to leave his house in his late teens.
The FMT procedure was undertaken by a specialist gastroenterologist in September 2020. Multiple pre-screening stool, urine and blood analyses were undertaken. He also had a CT scan of the pelvis and abdomen, as well as a colonoscopy and panendoscopy to rule out other possible issues that could be causing digestive issues.
For the month prior to FMT, he was prescribed antibiotics (rifaximin 500 mg/day and vancomycin 250 mg/day), followed a low- fiber diet (less than 10 g a day), and abstained from alcohol.
He ceased valproate (200 mg/day pre-FMT) two months after the procedure and began tapering the 250 mg/day dose of quetiapine four months after commencing FMT, with complete cessation occurring after six months.
At a subsequent review four months later, he reported that symptom improvement had either been maintained or further improved and that he had not taken any mood stabilizer for fifteen months, nor quetiapine for four months.
His bipolar condition had been moderately severe for a decade, and following FMT, there was a distinct improvement in mood oscillations, anxiety, and ADHD symptoms.
Of course that one case report can’t be translated to the general population, but the results in the patient were noticeable and showed us once more the importance of the gut microbiota not only in the digestive tract but also in other systems. Larger studies are needed in order to evaluate the use of FMT in patients with mood disorders.
Gordon Parker, et al. Faecal microbiota transplantation for bipolar disorder: A detailed case study. Bipolar Disorders. 2022;00:1–5.1 DOI: 10.1111/bdi.13187.