A Multiomics Approach To Anxiety, Depression, Stress

Not everyone responds to the same interventions, said David Brady, ND, at the 2023 Integrative Healthcare symposium in New York City. Therefore, practitioners must look to personalizing the treatment of depression, anxiety, hypervigilance, and post-traumatic stress disorder using microbiomics, metabolomics, and genomics.

It’s only recently been established that the gut communicates with the brain through the gut-brain axis, Brady said. In Victorian times, a syphilis-causing microbe was responsible for filling mental asylums, according to an article in the Harvard Review of Psychiatry. In another instance, a New Jersey hospital psychiatrist linked bacteria on his patient’s teeth to their psychoses. Now, we have started to connect gut bacteria to mood disorders and depression. 

People have known for generations that stress can cause issues in the gut, like ulcers, Brady said. Patients who are under a lot of stress for a long time or severe acute stress can develop irritable bowel syndrome (IBS), panic attack, insomnia, associated dysbiosis, fibromyalgia, low-grade or overt inflammation and ultimately tissue disease. But conventional psychiatrists and psychologists are generally not concerned with what’s happening in the gut and they’re not taking stool sample.

Brady spoke extensively on gut microbiota, citing the NIH Human Microbiome Project and a seminal review about the role of the gut microbiome in major depressive disorder in the Harvard Review of Psychiatry. Research has found that the microbiota in patients with depression are not the same as patients without depression, Brady said. They identified 13 different microbial taxa that were significantly and consistently different between depressed and non-depressed people. He advised practitioners not to get hung up on the individual genus or species of microbes that may be different when treating depression or anxiety because it’s not something that can be put in a pill and taken anyway, it’s anaerobic.

“There is an imbalance in the gut and it’s not in a favorable way, that’s really the main takeaway,” he said.

He also discussed the role of commensal probiotics in treating mood disorders, recommending a generalized approach in prescribing. If practitioners give patients probiotics, he explained, different species and strains of lactobacillus for example, depression and anxiety levels go down. While some of the studies using probiotics were done on a depressed population, others were done on patients with irritable bowel, chronic fatigue, or other chronic diseases that have depression and anxiety as a component of the symptom profile. What’s most important for practitioners to keep at the forefront, he said, is that the intervention, in this case probiotics, improved depression.

Probiotics are helpful in these situations as well as prebiotics, Brady said, referencing an IBS study using short chain fructo-oligosaccharides that showed improvement in anxiety.

While probiotics and prebiotics have shown improvement, establishing causality has proven difficult.

“The hardest lever we can pull on to actually change the compositional signatures of the microbiome is fecal microbial transplantation (FMT).”

One of the more well-known studies, he said, is with a single FMT procedure on men and women with IBS to improve depression and anxiety. What they uncovered, he said, is it that depressed people have a different and compositionally distinct microbiome than people without depression, but that doesn't prove any causality, that simply approves the association. He then pointed to a study where they took fecal microbial transplantation material from depressed humans implanted it into normal mice which then made them feel depressed  and anxious. The mice exhibited anhedonia-like presentations, showing they were no longer capable of feeling pleasure.

“They couldn't have good feelings anymore,” he said, “That's pretty cool. They take fecal microbial transplant material from depressed humans put it in the animals and the animals become depressed. That's causality right there.”

Brady’s topline takeaways to push the microbiota and the entire gastrointestinal ecology in a healthier direction and get better outcomes when it relates to mood, anxiety, stress, and sleep are as follows:

• Probiotics: Keep the gut healthy by eating probiotic-packed fermented foods like kimchi, sauerkraut, yogurt, kefir, and kombucha as well as prebiotics like jicama, dandelion green, garlic chicory root, and Jerusalem artichoke.
• Resistant Starch: Resistant starch creates positive flora as it ferments in the gut
• Exercise: Studies show that exercise and movement favorably alter the gut microbiome

He also shared recommendations on natural supplements he likes for a natural approach to mood including Zembrin, a patented form of the South African plant Sceletiumtortuosum. It has been used by the indigenous people for hundreds of years for relaxation, stress, thirst and hunger, soothing infants from colic and teething, he said. Research has proven its benefits in increasing mood state, cognitive function, reducing stress, inducing a calm but not sedative effect. He also discussed the impressive research on saffron, crocos sativus, which has been shown to have anti-depressant and anti-anxiolytic effects as potent as taking citalopram, according to studies.

Brady stressed the significance of using multiomics in practice. This can be done with noninvasive samples, Brady told practitioners, a buccal swab for genomics, stool for microbiomics, and urine for metabolomics. They can help practitioners target therapies, Brady said, and keeps them in the future lane.

“It's no more “this for that” nutrition,” Brady said. “Protocols are limited, they're generic. They're sort of vanilla approaches that are not personalized. Pretty soon, your patients won’t they need you to do that because that can all be done on the internet through some direct-to-consumer precision medical company. Doing this kind of thing in your practice is really where everything is headed”

Editor's note: This article is part of Integrative Practitioner's live coverage of the 2023 Integrative Healthcare Symposium at the Hilton Midtown in New York City. Click here to catch up on the live coverage.