Bowdoin Science Journal

Depression

The Dark Side of Antibiotics

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Antibiotics are medications that fight infections caused by bacteria. But they can also lead to mental health issues, such as anxiety and depression, later in life. 

The discovery of antibiotics was one of the greatest medical advances of the 20th century. Antibiotics have significantly reduced mortality from infectious diseases and increased average life expectancy. However, they have a variety of side effects, including cognitive impairment and emotional disorders in adulthood (Adedji 2016). 

Antibiotics destroy bacteria in the gut, which can disrupt brain function. Gut microbiota are an important component of the gut-brain axis–the two-way line of communication between the gastrointestinal tract and the central nervous system. Gut microbiota produce neurotransmitters that regulate mood, such as dopamine, norepinephrine, and serotonin, which travel through the vagus nerve to the brain (Karakan et al 2021). Previous studies have found that antibiotic-induced gut microbiota depletion causes dysfunction of the gut-brain axis, increasing anxiety and depression-related behaviors (Mosaferi et al 2021).

Aging plays an important role in the development of both gut microbiota and the brain. Microbiota first appear at birth and rapidly colonize the intestinal tract. The composition and diversity of gut microbiota resembles adult level by 2 years of age and remains stable throughout adulthood before decreasing in old age. The brain develops until the mid-to-late 20s and starts to decline in middle age. It has been shown that antibiotic-induced gut microbiota depletion has negative effects on the brain (Li et al 2022). However, no prior research has been done on this relationship during the different stages of life. This study aimed to determine the connection between gut microbiota and cognitive and emotional function during the different life stages. 

In this experiment, the researchers used mice as models for human subjects, randomly assigning 75 mice to five groups. One group served as the control (Veh group) and was given distilled water from birth to death. The other four groups were given an antibiotic cocktail at different life stages: birth to death (Abx group), birth to postnatal day 21 (Abx infant group), postnatal day 21 to 56 (Abx adolescence group), and postnatal day 57 to 84 (Abx adulthood group).  

At postnatal day 85, the researchers randomly selected thirteen mice from each group for testing. They measured the cognitive function and emotion of the mice by using four traditional behavioral tests: open-field test (OFT), passive avoidance test (PAT), morris water maze test (MWM), and tail suspension test (TST). The OFT measured anxiety level by observing how long the mice moved in an open field for 5 minutes. The PAT measured short-term memory, which was defined as the difference in latency–the time it took mice to reenter a room that delivered an electric shock–between day 1 and day 2 (Jahn-Eimermacher et al 2011). The MWM measured spatial memory, which was defined as incubation time, or how long it took mice to find a submerged platform in a pool after a 5-day training period. The TST measured depression state by observing the duration of quiescence (motionless state) of the mice while they were suspended upside down for 4 minutes.

Figure 1 | Results of OFT, PAT, MVM, and TST tests. Researchers conducted four traditional behavioral tests on mice given water, as well as mice given antibiotics at different stages of life: birth to death, infancy, adolescence, and adulthood. They found that exposure to antibiotics from birth to death and in infancy led to the most severe cognitive and emotional dysfunction, followed by exposure in adolescence and adulthood (Li et al 2022).

The results of this study suggested that life cycle stages influence the relationship between gut microbiota and cognitive and emotional function. For the OFT test, the total movement time of the Abx, Abx infant, and Abx adolescent groups was significantly lower than the Veh group, indicating they were more anxious than the Veh group (Figure 1). In other words, exposure to antibiotics from birth to death, in infancy, and in adolescence caused anxiety-related behaviors. For the PAT test, the difference in latency for every Abx group was significantly lower than the Veh group, meaning all Abx groups reentered the room with the electric shock more quickly after training. These results signaled that short-term memory loss was greater in the Abx groups than the Veh group; exposure to antibiotics at any stage of life caused short-term memory loss. The MWM test found that the incubation time after the 5-day training period was significantly higher for the Abx and Abx infant groups than the Veh group, so they experienced more spatial memory loss than the Veh group; exposure to antibiotics from birth to death and in infancy caused spatial memory loss. The TST test found that the duration of quiescence in the Abx and Abx infant groups was significantly higher than the Veh group, implying they were more depressed than the Veh group. In other words, exposure to antibiotics from birth to death and in infancy caused depression-related behaviors.

The researchers’ findings align with previous work showing that depletion of gut microbiota causes cognitive impairment and emotional problems (Lach et al 2020). Furthermore, the researchers demonstrated that life cycle stages are an important factor in the relationship between gut microbiota and cognitive and emotional function. In particular, their findings strengthened the idea that infancy is a crucial stage of development of gut microbiota and the brain (Hunter et al 2023). Gut microbiota lost in infancy recovers over time; however, this depletion has lasting cognitive effects. In this study, mice given antibiotics in infancy exhibited similar behaviors in adulthood as mice given antibiotics from birth to death: anxiety, depression, memory loss, and learning ability decline. Exposure to antibiotics in infancy and in the long term led to the most severe cognitive and emotional dysfunction, followed by exposure in adolescence and adulthood.

The researchers’ findings also have implications for the treatment of mental health illnesses. Previous studies have shown that probiotics replace depleted gut microbiota, alleviating symptoms of anxiety and depression. Antidepressants and anxiolytics–current medications for anxiety and depression–cause side effects such as nausea, weight gain, insomnia, constipation, dizziness, agitation, and restlessness. Probiotics are associated with milder side effects, including gas and bloating (Bistas et al 2023). Probiotics are unlikely to treat severe depression and anxiety, but they are promising treatments for people with milder conditions. The next step is to identify and manufacture effective probiotics, which would revolutionize the field of psychiatry and improve the lives of people around the world.

 

References

Adedji, W.A. 2016. THE TREASURE CALLED ANTIBIOTICS. Annals of Ibadan Postgraduate Medicine. 14(2):56-57. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5354621/.

Bistas KG, Tabet JP. 2023. The Benefits of Prebiotics and Probiotics on Mental Health. Cureus Journal of Medical Science. 15(8):e43217. doi:10.7759/cureus.43217.

Hunter S, Flaten E, Petersen C, Gervain J, Werker JF, Trainor LJ, Finlay BB. 2023. Babies, bugs and brains: How the early microbiome associates with infant brain and behavior development. PLOS One. 18(8):e0288689. doi:10.1371/journal.pone.0288689.

Jahn-Eimermacher A, Lasarzik I, Raber J. 2011. Statistical analysis of latency outcomes in behavioral experiments. Behavioural Brain Research. 221(1):271-275. doi:10.1016/j.bbr.2011.03.007.

Karakan T, Ozkul C, Akkol EK, Bilici S, Sobarzo-Sánchez E, Capasso R. 2021. Gut-Brain Microbiota Axis: Antibiotics and Functional Gastrointestinal Disorders. Nutrients. 13(2):389. doi:10.3390/nu13020389.

Lach G, Fülling C, Bastiaanssen TFS, Fouhy F, O’Donovan AN, Ventura-Silva AP, Stanton C, Dinan TG, Cryan JF. 2020. Translational Psychiatry. 10(1):382. doi:10.1038/s41398-020-01073-0.

Li J, Pu F, Peng C, Wang Y, Zhang Y, Wu S, Wang S, Shen X, Li Y, Cheng R, He F. 2022. Antibiotic cocktail-induced gut microbiota depletion in different stages could cause host cognitive impairment and emotional disorders in adulthood in different manners. Neurobiology of Disease. 170:105757. doi:10.1016/j.nbd.2022.105757.

Mosaferi B, Jand Y, Salari AA. 2021. Gut microbiota depletion from early adolescence alters anxiety and depression-related behaviors in male mice with Alzheimer-like disease. Scientific Reports. 11:22941. doi:10.1038/s41598-021-02231-0.

The Solution to Alzheimer’s May Lie in Depression

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Despite being discovered by Alois Alzheimer almost 120 years ago, Alzheimer’s Disease (AD) still remains incurable (Hippius & Neundörfer, 2003). AD causes the brain to break down over time, which is also known as neurodegeneration. AD begins by deterioration of the hippocampus, which is the part of the brain responsible for memory and emotion. It then slowly spreads to other parts of the brain, eventually breaking apart the brain stem, which is responsible for involuntary movements such as breathing and swallowing (Lee et al., 2015). Given that around 39 million people have Alzheimer’s worldwide and that this disease has a 100% fatality rate, scientists across the world have tried to find a cure to this ravaging disease (World Health Organization, 2023). While there is yet to be a cure, recent developments by Stephanie Langella could help with mitigating one of the earliest signs of Alzheimer’s: depressive symptoms.

In this study, Langella and her team studied Presenilin-1 (PSEN1) gene mutations, a major cause of early-onset Alzheimer’s Disease. The PSEN1 gene provides instructions for making the presenilin-1 protein. This protein is an essential part of a protein complex known as gamma-secretase. This complex cleaves toxic proteins such as the amyloid precursor protein (APP) to create nontoxic proteins. When the PSEN1 gene mutates, gamma-secretase struggles to form and break down these toxic proteins, causing APP molecules to join together to create amyloid-beta (also known as amyloid-ꞵ or A-ꞵ), the protein responsible for the neurodegeneration seen in Alzheimer’s Disease (Bagaria et al., 2022). 

A figure of gamma-secretase, APP processing, and generation of Amyloid-β (Aβ). Cleavages of C99 by gamma secretase (ε/ζ/γ) release sAPPβ, a type of APP which is beneficial to cells. When the PSEN1 gene mutates, gamma secretase (γ) produces AICD, a harmful type of APP, into a cell’s liquid (cytosol) and amyloid-β 37-43 into cell organelles. Aβ42 is the form of amyloid-β responsible for neurodegeneration in AD patients. (Steiner et al., 2018).

In particular, they studied its relationship to the neurodegeneration of the hippocampus and depressive symptoms (Langella et al., 2023). They began by creating two groups:  the first group consisted of carriers of the PSEN1 mutation but that had not yet been diagnosed with AD, and the second group consisted of the family members of the respective PSEN1 carriers that did not have the mutation and were not diagnosed with Alzheimer’s. Then, two structural MRIs – a method of neuroimaging which models the brain structures of a patient– with a one-year gap in between the two images were taken of the participants’ hippocampuses to measure the change in the volume of the hippocampus over a year. Participants also took the Geriatric Depression Scale, a 15-item survey that measures depressive symptoms, such as the subjects’ feelings of hopelessness and rating their interest in hobbies, to measure depressive symptoms over one year. 

Once the study was concluded, Langella found that there was no significant difference in the severity of the depressive symptoms between those carrying the PSEN1 mutation and those that did not. However, within the group carrying the PSEN1 mutation, those with smaller hippocampal volumes experienced more depressive symptoms. This association remained even after accounting for the age differences in the participants. This same association was not present in the non-PSEN1 carriers (Langella et al., 2023). Since the volume of the hippocampus did not have any relationship with depressive symptoms with non-PSEN1 carriers, there is likely some relationship between Alzheimer’s and depressive symptoms caused by hippocampal neurodegeneration. 

A).  Structural MRI of the hippocampus from the back of the head (shown in yellow)

C). Top-down structural MRI of the hippocampus (shown in yellow)  (Sato et al., 2021)

There are several important implications of this research. To start, if there is indeed a relationship between the severity of depressive symptoms and the size of the hippocampus in someone with AD, there is a chance that trying to mitigate these depressive symptoms through therapy and antidepressant medication could slow down the deterioration of the hippocampus. By keeping the hippocampus intact for a longer time, people with AD could have better emotional control and memory later in life, which would greatly improve their quality-of-life (Langella et al., 2023). Also, since AD first deteriorates the hippocampus, it is possible that the onset of depressive symptoms in people with the PSEN1 mutation could be used as an indicator to doctors on the severity of the neurodegeneration. For instance, if someone with the PSEN1 gene mutation suddenly begins displaying depressive symptoms, it is possible that AD has just recently started decaying the hippocampus. Doctors can then try to intervene and slow the decay of the hippocampus through administering antidepressants and therapy, but also through encouraging lifestyle changes such as increased exercise. This way, those with Alzheimer’s can live a longer time before their hippocampus fully degrades, letting them keep their memories for a longer time. 

Since this is one of the first studies relating depression and hippocampal decay in people with PSEN1 mutations, there is no theorized mechanism behind why this relationship exists in people with the PSEN1 mutation but not in those without. However, Langella et al. did find a particularly strong association between hippocampal decay in those with the PSEN1 mutation and displaying apathy, one of the measured depressive symptoms in the study (2023). More research should be done on the potential role of certain depressive symptoms on hippocampal decay, along with more research on the neural underpinnings relating the PSEN1 mutation, depression symptoms, and hippocampal decay. There is some evidence linking the formation of amyloid-ꞵ to depression in late-life major depression, but further research into the mechanism underlying this relationship is required (Pomara et al., 2022). 

However, there is a pressing issue with this study; it had a fairly small sample size, with the PSEN1 carrier group having 27 participants and the non-PSEN1 group having 26. Since AD is a disease that affects everyone slightly differently, having such a small sample size makes the results unreliable and hard to generalize to everyone with AD. Regardless of the issues in the study, developments such as the ones created by this study serve to improve the quality of life and life expectancy of people with AD, which promises to improve the lives of almost 39 million people and their families. With every passing discovery into Alzheimer’s, scientists are also getting more information on the mechanisms behind the disease, which could eventually lead humanity to curing the disease altogether. 

 

Citations

Bagaria, J., Bagyinszky, E., & An, S. S. A. (2022). Genetics, Functions, and Clinical Impact of Presenilin-1 (PSEN1) Gene. International journal of molecular sciences, 23(18), 10970. https://doi.org/10.3390/ijms231810970

 

Hippius, H., & Neundörfer, G. (2003). The discovery of Alzheimer’s disease. Dialogues in clinical neuroscience, 5(1), 101–108. https://doi.org/10.31887/DCNS.2003.5.1/hhippius

 

Langella S,  Lopera F,  Baena A, et al.  Depressive symptoms and hippocampal volume in autosomal dominant Alzheimer’s disease. Alzheimer’s Dement.  14 Oct. 2023, 986–994. https://doi.org/10.1002/alz.13501

 

Lee, J. H., Ryan, J., Andreescu, C., Aizenstein, H., & Lim, H. K. (2015). Brainstem morphological changes in Alzheimer’s disease. Neuroreport, 26(7), 411–415. https://doi.org/10.1097/WNR.0000000000000362

 

Pomara, N., Bruno, D., Plaska, C.R. et al. Plasma Amyloid-β dynamics in late-life major depression: a longitudinal study. Transl Psychiatry 12, 301 (2022). https://doi.org/10.1038/s41398-022-02077-8

 

Sato, Jinya, et al. “Lower Hippocampal Volume in Patients with Schizophrenia and Bipolar  Disorder: A Quantitative MRI Study.” Journal of Personalized Medicine, vol. 11, no. 2, 13 Feb. 2021, p. 121, https://doi.org/10.3390/jpm11020121.

 

Steiner, H., Fukumori, A., Tagami, S., & Okochi, M. (2018, October 28). Making the final cut: Pathogenic amyloid-β peptide generation by γ-secretase. The Journal of Cellular Pathology. https://www.cell-stress.com/researcharticles/making-the-final-cut-pathogenic-amyloid-%ce%b2-peptide-generation-by-%ce%b3-secretase

 

World Health Organization. “Dementia.” Dementia, 2023, www.who.int/news-room/fact-sheets/detail/dementia.