A Promising Treatment for Mental Disorders: Fecal Transplants

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In November 2016, Jane Dudley was waiting impatiently in her kitchen. As she stood there she felt a mix of emotions, nervousness, a bit of disgust, a touch of hope and a lot of “what do I have to lose?” Her husband, Alexander, came in and handed her his own feces. She took the feces and put them in her blender, adding saline solution before hitting the switch and watching the machine turn on.

Fecal microbiota transplantation (FMT) is what it sounds like: a process in which feces and associated bacteria are usually transferred from one person to another. The goal is to take good bacteria from a healthy donor and use them to repopulate the gut of someone thought to have an unhealthy microbiome.

FMT has been around since the fourth century, when China treated severe diarrhea and food poisoning. It may sound a little (or a lot) disgusting, but it is a growing field of research. Researchers are studying FMT as a possible treatment for obesity, irritable bowel syndrome, intestinal and metabolic disorders, and now mental disorders.

The link between the brain and the gut

In Australia, FMT is currently only approved for the treatment of recurrent infection with Clostridium difficile bacteria. And even then, experts must perform the fecal transplant in a clinical setting. However, the results of treatment for It’s hard are promising, with cure rate of about 90 percent. And experts believe that FMT could also benefit the treatment of conditions such as bipolar and major depressive disorder.

The brain and gut may seem separate, but they are in constant communication with each other. This two-way communication between the central nervous system (composed of the brain and spine) and the enteric nervous system (located in the gut and often called the second brain) is known as the gut-brain axis.

Have you ever had butterflies in your stomach before you met someone? Or did you have a stomach ache the morning of a big presentation? It is the influence of the brain on the gut. And it also works the other way around.

While evidence suggests a link between diseases such as depression and unhealthy gut bacteria, recent studies have focused primarily on rodents, studying the gut microbiome and mental health. Research in this area is limited, however, researchers in a 2016 study transplanted feces from depressed humans into mice and induced depression-like symptoms in the animals. What they found was promising.

“We are optimistic. But the evidence is very early, for mental health anyway. In humans, the evidence is mostly case studies, which are very informative, but not definitive as a number of other factors could explain the results,” says Dr. Jessica Green of the University’s Mood and Food Center. Deakin.

Dudley was at the center of one of these case studies – one of only two that were written in Australia. At the age of 29, she was diagnosed with bipolar 1 and even when on medication she was regularly hospitalized.

“It took a few years to find drugs that stabilized me. They kinda stopped me [from] be suicidal, but that was it. Every day was endless suffering. The only relief I had from depression was that maybe twice a year I was going manic. I was completely crippled by this disease,” says Dudley.

Help mental illnesses

It was Dudley’s husband who first suggested they try a do-it-yourself (DIY) fecal transplant. Although initially disgusted by the idea, Jane was desperate and Alex was incredibly healthy and happy to be a donor. It seemed like a perfect fit and she saw her psychiatrist who agreed to monitor her. Looking back, she admits a home-based approach was risky.

“In 2016, we were reckless. We didn’t really understand how dangerous poop transplants could be,” says Dudley.

For security reasons, Green says, “We absolutely do not condone DIY FMT. People have died from FMT without proper screening. The regulations in Australia are extremely strict, but when followed they are considered an extremely safe procedure.

And while safety in the clinical setting is not an issue, some need to consider tolerability. Green has just completed recruiting a feasibility study on the treatment of depression by FMT. At this point, there are no other published studies on FMT for depression, so this study might even be a world first.

But how is feces transferred to the patient? There are several ways, like an endoscope, a crapsule (yes, that’s exactly what you think it is) or an enema. And it’s the latter that Green will test, to see how tolerable people with major depressive disorder find the process of having four enemas on four consecutive days. If all goes well, the goal is to conduct a much larger study next year.

If FMT is found to be successful in alleviating symptoms of depression, a safe treatment protocol is still years away. In the meantime, there are other ways people can improve their mental health.

“We have promising evidence from a randomized, controlled trial where we asked people to change their diets to increase their intake of fruits, vegetables, whole grains, legumes, nuts and seeds and a decrease in consumption of ultra-processed foods,” according to Dr. Tetyana Rocks of the Mood and Food Centre.

the SMILE trial, conducted at Deakin University, showed that “in just twelve weeks, changing diet in this way actually improved mental health outcomes.” In fact, the study found that simply increasing consumption of these foods and reducing consumption of ultra-processed foods led to remission of depression in a third of participants.

Nearly six years after embarking on her feces experiment in November 2016, Dudley retired her blender. After performing ten faecal transplants, she was found depression-free in March the following year and, under the supervision of her psychiatrist, drug-free in August. Today, she is doing well and living a full life. About the transformation, she says, “I started loving myself for no reason. I started feeling joy for no reason. I went from being completely disabled to being a fully functioning adult.

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