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Fecal microbiota transplantation (FMT) was associated with improved mental health outcomes for patients with recurrent Clostridioides difficile infections (CDI), according to a small Dutch observational study.

In a multivariate analysis adjusting for sex, age, and history of depression, FMT was associated with improvements in self-rated health (chi-squared 22.88, P<0.001) and severity of depression (chi-squared 15.09, P<0.001) at 4 weeks, which persisted through 26 weeks, reported Erik Giltay, MD, PhD, of the Leiden University Medical Center in The Netherlands, and colleagues.

"Detailed analyses showed improvements in overeating or loss of appetite, loss of interest and pleasure in doing activities, feeling fatigue or lacking energy, feeling depressed or hopeless, difficulty in concentrating, difficulty with sleeping, moving or speaking slowly or fast and feeling tense or wound up," the authors wrote in the .

However, they said that while severity of depression was improved on the Patient Health Questionnaire-9, they did not observe a difference on the Hospital Anxiety and Depression Scale.

"As gastrointestinal symptoms improved and low-grade inflammation can play a role in the pathogenesis of somatic and sickness behavior symptoms ... the effective treatment of recurrent CDI could explain the improvement of these symptoms," they noted.

FMT is recommended for recurrent CDI that fails to respond to antibiotic therapy, but there remains a lack of data on its impact on mental health. Case reports have suggested neurologic improvements with FMT for patients with multiple sclerosis, Parkinson's disease, and Tourette syndrome, as has a of FMT in patients with autism and gastrointestinal symptoms.

"Future research should answer the question whether these effects are due to clinical recovery, or whether they are partly mediated through gut microbiota changes on psychological well-being," the authors noted.

For this study, Giltay and colleagues examined data on 49 adults who underwent FMT for recurrent CDI using fecal suspensions from physically and mentally healthy donors from May 2017 to February 2020. Of these patients, 34 finished short-term follow-up at 4 weeks and long-term follow-up at 26 weeks. The other 15 completed the short-term follow-up only (one patient discontinued the study because of severe illness, 12 for unknown reasons, and two died).

Patients had a mean age of 68, and two-thirds were women. Over a third had a history of depression. Three were on antidepressants at baseline, and two were on quetiapine. Of the 34 patients who completed 26-week follow-up, 17.6% were hospitalized post-FMT, and 17.6% developed a new non-CDI infection.

Patients completed the mental health questionnaires the day before FMT and at both follow-up visits. FMT was performed by infusion of 198 mL of donor fecal suspension through a nasoduodenal tube in 45 patients and a colonoscope in two patients. Both techniques were used for two patients who required multiple FMTs. Three patients received anti-CDI antibiotics.

At 4 weeks' post-FMT, patients reported mostly mild symptoms of diarrhea (25%), abdominal pain (25%), constipation (23%), and nausea (15%). Defecation improved for 36% of patients, while 13% reported worsening defecation, which was similar at 26 weeks.

At 2 months, the cure rate of a single FMT was 87.8%; six patients experienced a CDI relapse. At 26 weeks, all who completed the study had been cured.

Giltay and team acknowledged some limitations to their study, including the small sample size and lack of a control group. Also, data pertaining to a history of anxiety or other psychiatric disorders were unavailable.

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