, Volume 236, Issue 5, pp 1433–1443 | Cite as

Gut microbiota and bipolar disorder: a review of mechanisms and potential targets for adjunctive therapy

  • Shakuntla GondaliaEmail author
  • Lisa Parkinson
  • Con Stough
  • Andrew Scholey


There is increasing evidence that connections formed between microbiome, the gut, and the brain play a role in health and well-being. Non-pharmaceutical targets for management of mood disorders, such as bipolar disorder, are relatively under-researched. At the same time, it is clear that there is an intimate connection between psychiatry and gastrointestinal health. Here, we have discussed various comorbid conditions associated with bipolar disorders such as inflammation, irritable bowel disease and antibiotic induced mania with importance to demonstrate possible involvement of the gut microbiota. Gut microbiota–targeted preclinical and clinical interventions have demonstrated enhancement in various psychological conditions. Further in this review, we explore links between bipolar disorder, inflammation and gut microbiome with a focus on dietary, pro- and pre-biotic interventions as potential adjuvant therapies for use in the management of mood disorders such as bipolar disorder.


Bipolar disorder Gut microbiome Immunity Antibiotic Inflammation Adjuvant therapy Probiotics Antibiomania 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. Akkasheh G, Kashani-Poor Z, Tajabadi-Ebrahimi M et al (2016) Clinical and metabolic response to probiotic administration in patients with major depressive disorder: a randomized, double-blind, placebo-controlled trial. Nutrition 32:315–320. CrossRefPubMedGoogle Scholar
  2. Alshikh N, de Camargo AC, Shahidi F (2015) Phenolics of selected lentil cultivars: Antioxidant activities and inhibition of low-density lipoprotein and DNA damage. J Funct Foods 18:1022–1038CrossRefGoogle Scholar
  3. Asan E, Steinke M, Lesch K-P (2013) Serotonergic innervation of the amygdala: targets, receptors, and implications for stress and anxiety. Histochem Cell Biol 139:785–813. CrossRefPubMedGoogle Scholar
  4. Åsberg M (1997) Neurotransmitters and suicidal behavior. Ann N Y Acad Sci 836:158–181PubMedCrossRefGoogle Scholar
  5. Barbosa IG, Morato IB, de Miranda AS, Bauer ME, Soares JC, Teixeira AL (2014) A preliminary report of increased plasma levels of IL-33 in bipolar disorder: further evidence of pro-inflammatory status. J Affect Disord 157:41–44PubMedCrossRefGoogle Scholar
  6. Barrett E, Ross RP, O'Toole PW, Fitzgerald GF, Stanton C (2012) γ-Aminobutyric acid production by culturable bacteria from the human intestine. J Appl Microbiol 113 (2):411–417PubMedCrossRefGoogle Scholar
  7. Benros ME, Waltoft BL, Nordentoft M, Østergaard SD, Eaton WW, Krogh J, Mortensen PB (2013) Autoimmune diseases and severe infections as risk factors for mood disorders: a nationwide study. JAMA Psychiatry 70:812–820PubMedCrossRefGoogle Scholar
  8. Benton D, Williams C, Brown A (2007) Impact of consuming a milk drink containing a probiotic on mood and cognition. Eur J Clin Nutr 61:355CrossRefPubMedPubMedCentralGoogle Scholar
  9. Bercik P, Park A, Sinclair D et al (2011) The anxiolytic effect of Bifidobacterium longum NCC3001 involves vagal pathways for gut–brain communication. Neurogastroenterol Motil 23:1132–1139PubMedPubMedCentralCrossRefGoogle Scholar
  10. Berk M, Kapczinski F, Andreazza A et al (2011) Pathways underlying neuroprogression in bipolar disorder: focus on inflammation, oxidative stress and neurotrophic factors. Neurosci Biobehav Rev 35:804–817PubMedCrossRefPubMedCentralGoogle Scholar
  11. Beydoun MA, Shroff MR, Beydoun HA, Zonderman AB (2010) Serum folate, vitamin B-12 and homocysteine and their association with depressive symptoms among US adults. Psychosom Med 72:862–873PubMedPubMedCentralCrossRefGoogle Scholar
  12. Bomba A, Nemcova R, Gancarcikova S, Herich R, Guba P, Mudronova D (2002) Improvement of the probiotic effect of micro-organisms by their combination with maltodextrins, fructo-oligosaccharides and polyunsaturated fatty acids. Br J Nutr 88:S95–S99PubMedCrossRefPubMedCentralGoogle Scholar
  13. Boufidou F, Nikolaou C, Alevizos B, Liappas IA, Christodoulou GN (2004) Cytokine production in bipolar affective disorder patients under lithium treatment. J Affect Disord 82:309–313PubMedCrossRefPubMedCentralGoogle Scholar
  14. Bravo JA, Forsythe P, Chew MV et al (2011) Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. Proc Natl Acad Sci 108:16050–16055PubMedCrossRefGoogle Scholar
  15. Cebra JJ (1999) Influences of microbiota on intestinal immune system development. Am J Clin Nutr 69:1046s–1051s. CrossRefPubMedPubMedCentralGoogle Scholar
  16. Collins SM (2014) A role for the gut microbiota in IBS. Nat Rev Gastroenterol Hepatol 11:497–505. CrossRefPubMedPubMedCentralGoogle Scholar
  17. Cryan JF, Dinan TG (2012) Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour. Nat Rev Neurosci 13:701–712. CrossRefPubMedPubMedCentralGoogle Scholar
  18. Cunha AB, Andreazza AC, Gomes FA, Frey BN, Da Silveira LE, Gonçalves CA, Kapczinski F (2008) Investigation of serum high-sensitive C-reactive protein levels across all mood states in bipolar disorder. Eur Arch Psychiatry Clin Neurosci 258:300–304PubMedCrossRefPubMedCentralGoogle Scholar
  19. Cussotto S, Strain CR, Fouhy F et al (2018) Differential effects of psychotropic drugs on microbiome composition and gastrointestinal function. Psychopharmacology. CrossRefGoogle Scholar
  20. Dargél AA, Godin O, Kapczinski F, Kupfer DJ, Leboyer M (2015) C-reactive protein alterations in bipolar disorder: a meta-analysis. J Clin Psychiatry: 76(2):142–150PubMedCrossRefPubMedCentralGoogle Scholar
  21. Davison KM, Kaplan BJ (2012) Nutrient intakes are correlated with overall psychiatric functioning in adults with mood disorders. Can J Psychiatry 57:85–92PubMedCrossRefPubMedCentralGoogle Scholar
  22. Dayan P, Huys QJ (2008) Serotonin, inhibition, and negative mood. PLoS Comput Biol 4:e4. CrossRefPubMedPubMedCentralGoogle Scholar
  23. Dickerson F, Stallings C, Origoni A, Boronow J, Yolken R (2007) Elevated serum levels of C-reactive protein are associated with mania symptoms in outpatients with bipolar disorder. Prog Neuro-Psychopharmacol Biol Psychiatry 31:952–955CrossRefGoogle Scholar
  24. Dickerson F, Katsafanas E, Schweinfurth L et al (2015) Immune alterations in acute bipolar depression. Acta Psychiatr Scand 132:204–210PubMedCrossRefPubMedCentralGoogle Scholar
  25. Dickerson F, Adamos M, Katsafanas E et al (2018) Adjunctive probiotic microorganisms to prevent rehospitalization in patients with acute mania: a randomized controlled trial. Bipolar Disord 20:614–621. CrossRefPubMedPubMedCentralGoogle Scholar
  26. Drexhage RC, Knijff EM, Padmos RC, Heul-Nieuwenhuijzen L, Beumer W, Versnel MA, Drexhage HA (2010) The mononuclear phagocyte system and its cytokine inflammatory networks in schizophrenia and bipolar disorder. Expert Rev Neurother 10:59–76CrossRefPubMedGoogle Scholar
  27. Engeland CG, Kavaliers M, Ossenkopp K-P (2003) Sex differences in the effects of muramyl dipeptide and lipopolysaccharide on locomotor activity and the development of behavioral tolerance in rats. Pharmacol Biochem Behav 74:433–447PubMedCrossRefPubMedCentralGoogle Scholar
  28. Evans SJ, Bassis CM, Hein R, Assari S, Flowers SA, Kelly MB, Young VB, Ellingrod VE, McInnis MG (2017) The gut microbiome composition associates with bipolar disorder and illness severity. J Psychiatr Res 87:23–29. CrossRefPubMedPubMedCentralGoogle Scholar
  29. Fond G, Loundou A, Hamdani N, Boukouaci W, Dargel A, Oliveira J, Roger M, Tamouza R, Leboyer M, Boyer L (2014) Anxiety and depression comorbidities in irritable bowel syndrome (IBS): a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 264:651–660PubMedCrossRefPubMedCentralGoogle Scholar
  30. Frangou S, Lewis M, McCrone P (2006) Efficacy of ethyl-eicosapentaenoic acid in bipolar depression: randomised double-blind placebo-controlled study. Br J Psychiatry 188:46–50PubMedCrossRefGoogle Scholar
  31. Gao J (2013) Correlation between anxiety-depression status and cytokines in diarrhea-predominant irritable bowel syndrome. Exp Ther Med 6:93–96PubMedPubMedCentralCrossRefGoogle Scholar
  32. Garud S, Leffler D, Dennis M et al (2009) Interaction between psychiatric and autoimmune disorders in coeliac disease patients in the Northeastern United States. Aliment Pharmacol Ther 29:898–905PubMedPubMedCentralCrossRefGoogle Scholar
  33. Geddes JR, Miklowitz DJ (2013) Treatment of bipolar disorder. Lancet 381:1672–1682PubMedCrossRefGoogle Scholar
  34. Gerner RH, Post RM, Bunney WE (1976) A dopaminergic mechanism in mania. Am J Psychiatry 133(10):1177–1180Google Scholar
  35. Gershon A, Eidelman P (2015) Inter-episode affective intensity and instability: predictors of depression and functional impairment in bipolar disorder. J Behav Ther Exp Psychiatry 46:14–18PubMedCrossRefGoogle Scholar
  36. Gitlin MJ, Swendsen J, Heller TL, Hammen C (1995) Relapse and impairment in bipolar disorder. Am J Psychiatry 152:1635PubMedCrossRefGoogle Scholar
  37. Goehler LE, Park SM, Opitz N, Lyte M, Gaykema RP (2008) Campylobacter jejuni infection increases anxiety-like behavior in the holeboard: possible anatomical substrates for viscerosensory modulation of exploratory behavior. Brain Behav Immun 22:354–366PubMedCrossRefGoogle Scholar
  38. Goldstein BI, Kemp DE, Soczynska JK, McIntyre RS (2009) Inflammation and the phenomenology, pathophysiology, comorbidity, and treatment of bipolar disorder: a systematic review of the literature. J Clin Psychiatry 70:1078, 1090Google Scholar
  39. Goldstein BI, Collinger KA, Lotrich F, Marsland AL, Gill M-K, Axelson DA, Birmaher B (2011) Preliminary findings regarding proinflammatory markers and brain-derived neurotrophic factor among adolescents with bipolar spectrum disorders. J Child Adolesc Psychopharmacol 21:479–484PubMedPubMedCentralCrossRefGoogle Scholar
  40. Gomez de Agüero M, Ganal-Vonarburg SC, Fuhrer T et al (2016) The maternal microbiota drives early postnatal innate immune development. Science 351:1296–1302. CrossRefPubMedPubMedCentralGoogle Scholar
  41. Gracious BL, Chirieac MC, Costescu S, Finucane TL, Youngstrom EA, Hibbeln JR (2010) Randomized, placebo-controlled trial of flax oil in pediatric bipolar disorder. Bipolar Disord 12:142–154PubMedPubMedCentralCrossRefGoogle Scholar
  42. Hamdani N, Doukhan R, Kurtlucan O, Tamouza R, Leboyer M (2013) Immunity, inflammation, and bipolar disorder: diagnostic and therapeutic implications. Curr Psychiatry Rep 15:387PubMedCrossRefPubMedCentralGoogle Scholar
  43. Hamdani N, Boukouaci W, Hallouche MR, Charron D, Krishnamoorthy R, Leboyer M, Tamouza R (2015) Resolution of a manic episode treated with activated charcoal: Evidence for a brain–gut axis in bipolar disorder. Aust N Z J Psychiatry 49:1221–1223PubMedCrossRefPubMedCentralGoogle Scholar
  44. Hope S, Dieset I, Agartz I et al (2011) Affective symptoms are associated with markers of inflammation and immune activation in bipolar disorders but not in schizophrenia. J Psychiatr Res 45:1608–1616PubMedCrossRefGoogle Scholar
  45. Ismail NA, Ragab SH, ElBaky AA, Shoeib AR, Alhosary Y, Fekry D (2011) Frequency of Firmicutes and Bacteroidetes in gut microbiota in obese and normal weight Egyptian children and adults. Arch Med Sci 7:501CrossRefGoogle Scholar
  46. Jacka FN, Pasco JA, Mykletun A et al (2010) Association of Western and traditional diets with depression and anxiety in women. Am J Psychiatr 167:305–311PubMedCrossRefGoogle Scholar
  47. Jacka FN, Pasco JA, Mykletun A, Williams LJ, Nicholson GC, Kotowicz MA, Berk M (2011) Diet quality in bipolar disorder in a population-based sample of women. J Affect Disord 129:332–337PubMedCrossRefGoogle Scholar
  48. Jacka FN, O’Neil A, Opie R et al (2017) A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Med 15:23PubMedPubMedCentralCrossRefGoogle Scholar
  49. Jacobs D, Silverstone T (1986) Dextroamphetamine-induced arousal in human subjects as a model for mania. Psychol Med 16:323–329PubMedCrossRefGoogle Scholar
  50. Kapczinski F, Dal-Pizzol F, Teixeira AL et al (2011) Peripheral biomarkers and illness activity in bipolar disorder. J Psychiatr Res 45:156–161PubMedCrossRefPubMedCentralGoogle Scholar
  51. Kim Y-K, Jung H-G, Myint A-M, Kim H, Park S-H (2007) Imbalance between pro-inflammatory and anti-inflammatory cytokines in bipolar disorder. J Affect Disord 104:91–95PubMedCrossRefPubMedCentralGoogle Scholar
  52. Köhler O, Petersen L, Mors O, Mortensen P, Yolken R, Gasse C, Benros M (2017) Infections and exposure to anti-infective agents and the risk of severe mental disorders: a nationwide study. Acta Psychiatr Scand 135:97–105PubMedCrossRefPubMedCentralGoogle Scholar
  53. Koo J, Marangell LB, Nakamura M, Armstrong A, Jeon C, Bhutani T, Wu JJ (2017) Depression and suicidality in psoriasis: review of the literature including the cytokine theory of depression. J Eur Acad Dermatol Venereol 31:1999–2009. CrossRefPubMedPubMedCentralGoogle Scholar
  54. Ladabaum U, Boyd E, Zhao WK, Mannalithara A, Sharabidze A, Singh G, Chung E, Levin TR (2012) Diagnosis, comorbidities, and management of irritable bowel syndrome in patients in a large health maintenance organization. Clin Gastroenterol Hepatol 10:37–45PubMedCrossRefPubMedCentralGoogle Scholar
  55. Leboyer M, Soreca I, Scott J, Frye M, Henry C, Tamouza R, Kupfer DJ (2012) Can bipolar disorder be viewed as a multi-system inflammatory disease? J Affect Disord 141:1–10PubMedPubMedCentralCrossRefGoogle Scholar
  56. Lee Y-T, Hu L-Y, Shen C-C et al (2015) Risk of psychiatric disorders following irritable bowel syndrome: a nationwide population-based cohort study. PLoS One 10:e0133283PubMedPubMedCentralCrossRefGoogle Scholar
  57. Legendre T, Boudebesse C, Henry C, Etain B (2017) Antibiomania: think of the manic syndrome secondary to antibiotic therapy. Encephale 43:183–186PubMedCrossRefPubMedCentralGoogle Scholar
  58. Leonard B, Maes M (2012) Mechanistic explanations how cell-mediated immune activation, inflammation and oxidative and nitrosative stress pathways and their sequels and concomitants play a role in the pathophysiology of unipolar depression. Neurosci Biobehav Rev 36:764–785PubMedCrossRefPubMedCentralGoogle Scholar
  59. Liu C-J, Hu L-Y, Yeh C-M, Hu Y-W, Chen P-M, Chen T-J, Lu T (2015) Irritable brain caused by irritable bowel? A nationwide analysis for irritable bowel syndrome and risk of bipolar disorder. PLoS One 10:e0118209PubMedPubMedCentralCrossRefGoogle Scholar
  60. Lopresti AL, Jacka FN (2015) Diet and bipolar disorder: a review of its relationship and potential therapeutic mechanisms of action. J Altern Complement Med 21:733–739PubMedCrossRefGoogle Scholar
  61. Lyte M (2011) Probiotics function mechanistically as delivery vehicles for neuroactive compounds: Microbial endocrinology in the design and use of probiotics. BioEssays 33(8):574–581PubMedCrossRefGoogle Scholar
  62. Maes M (2008) The cytokine hypothesis of depression: inflammation, oxidative & nitrosative stress (IO&NS) and leaky gut as new targets for adjunctive treatments in depression. Neuro Endocrinol Lett 29:287–291PubMedGoogle Scholar
  63. Magalhaes P, Kapczinski F, Nierenberg A, Deckersbach T, Weisinger D, Dodd S, Berk M (2012) Illness burden and medical comorbidity in the Systematic Treatment Enhancement Program for Bipolar Disorder. Acta Psychiatr Scand 125:303–308PubMedCrossRefPubMedCentralGoogle Scholar
  64. Mass M, Kubera M, Leunis J-C (2008) The gut-brain barrier in major depression: intestinal mucosal dysfunction with an increased translocation of LPS from gram negative enterobacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression. Neuroendocrinol Lett 29:117–124Google Scholar
  65. Mayer EA, Tillisch K, Gupta A (2015) Gut/brain axis and the microbiota. J Clin Invest 125:926–938. CrossRefPubMedPubMedCentralGoogle Scholar
  66. McNamara RK (2015) Mitigation of inflammation-induced mood dysregulation by long-chain omega-3 fatty acids. J Am Coll Nutr 34:48–55PubMedPubMedCentralCrossRefGoogle Scholar
  67. Meador-Woodruff JH, Hogg AJ Jr, Smith RE (2001) Striatal ionotropic glutamate receptor expression in schizophrenia, bipolar disorder, and major depressive disorder. Brain Res Bull 55:631–640PubMedCrossRefPubMedCentralGoogle Scholar
  68. Molteni R, Barnard RJ, Ying Z, Roberts CK, Gomez-Pinilla F (2002) A high-fat, refined sugar diet reduces hippocampal brain-derived neurotrophic factor, neuronal plasticity, and learning. Neuroscience 112(4):803–814PubMedCrossRefPubMedCentralGoogle Scholar
  69. Mueller HT, Meador-Woodruff JH (2004) NR3A NMDA receptor subunit mRNA expression in schizophrenia, depression and bipolar disorder. Schizophr Res 71:361–370PubMedCrossRefPubMedCentralGoogle Scholar
  70. Munkholm K, Vinberg M, Kessing LV (2013) Cytokines in bipolar disorder: a systematic review and meta-analysis. J Affect Disord 144:16–27PubMedCrossRefGoogle Scholar
  71. Murphy BL, Stoll AL, Harris PQ, Ravichandran C, Babb SM, Carlezon WA Jr, Cohen BM (2012) Omega-3 fatty acid treatment, with or without cytidine, fails to show therapeutic properties in bipolar disorder: a double-blind, randomized add-on clinical trial. J Clin Psychopharmacol 32:699–703PubMedCrossRefGoogle Scholar
  72. Myint AM, Kim Y-K, Verkerk R, Park SH, Scharpé S, Steinbusch HWM, Leonard BE (2007) Tryptophan breakdown pathway in bipolar mania. J Affect Disord 102:65–72. CrossRefPubMedGoogle Scholar
  73. Mykletun A, Jacka F, Williams L et al (2010) Prevalence of mood and anxiety disorder in self reported irritable bowel syndrome (IBS). An epidemiological population based study of women. BMC Gastroenterol 10:88PubMedPubMedCentralCrossRefGoogle Scholar
  74. Nielsen PR, Benros ME, Mortensen PB (2013) Hospital contacts with infection and risk of schizophrenia: a population-based cohort study with linkage of Danish national registers. Schizophr Bull 40:1526–1532PubMedPubMedCentralCrossRefGoogle Scholar
  75. O’Mahony SM, Clarke G, Borre YE, Dinan TG, Cryan JF (2015) Serotonin, tryptophan metabolism and the brain-gut-microbiome axis. Behav Brain Res 277:32–48. CrossRefPubMedGoogle Scholar
  76. O’Neil A, Berk M, Itsiopoulos C et al (2013) A randomised, controlled trial of a dietary intervention for adults with major depression (the “SMILES” trial): study protocol. BMC Psychiatry 13:114PubMedPubMedCentralCrossRefGoogle Scholar
  77. Painold A, Mörkl S, Kashofer K et al (2018) A step ahead: exploring the gut microbiota in inpatients with bipolar disorder during a depressive episode. Bipolar Disord. PubMedPubMedCentralCrossRefGoogle Scholar
  78. Parkinson L, Keast R (2014) Oleocanthal, a phenolic derived from virgin olive oil: a review of the beneficial effects on inflammatory disease. Int J Mol Sci 15:12323–12334PubMedPubMedCentralCrossRefGoogle Scholar
  79. Perlis RH, Ostacher MJ, Patel JK et al (2006) Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatr 163:217–224PubMedCrossRefGoogle Scholar
  80. Pinto-Sanchez MI, Hall GB, Ghajar K et al (2017) Probiotic Bifidobacterium longum NCC3001 reduces depression scores and alters brain activity: a pilot study in patients with irritable bowel syndrome. Gastroenterology 153:448–459 e448. CrossRefPubMedPubMedCentralGoogle Scholar
  81. Pompili M, Gonda X, Serafini G et al (2013) Epidemiology of suicide in bipolar disorders: a systematic review of the literature. Bipolar Disord 15:457–490PubMedCrossRefPubMedCentralGoogle Scholar
  82. Post RM (2007) Role of BDNF in bipolar and unipolar disorder: clinical and theoretical implications. J Psychiatr Res 41:979–990PubMedCrossRefPubMedCentralGoogle Scholar
  83. Rahe C, Unrath M, Berger K (2014) Dietary patterns and the risk of depression in adults: a systematic review of observational studies. Eur J Nutr 53:997–1013PubMedCrossRefPubMedCentralGoogle Scholar
  84. Reedy J, Krebs-Smith SM, Miller PE, Liese AD, Kahle LL, Park Y, Subar AF (2014) Higher diet quality is associated with decreased risk of all-cause, cardiovascular disease, and cancer mortality among older adults. J Nutr 144:881–889PubMedPubMedCentralCrossRefGoogle Scholar
  85. Reininghaus EZ, Wetzlmair LC, Fellendorf FT et al (2018) The impact of probiotic supplements on cognitive parameters in euthymic individuals with bipolar disorder: a pilot study. Neuropsychobiology:1–8.
  86. Romijn AR, Rucklidge JJ, Kuijer RG, Frampton C (2017) A double-blind, randomized, placebo-controlled trial of Lactobacillus helveticus and Bifidobacterium longum for the symptoms of depression. Aust N Z J Psychiatry 51:810–821. CrossRefPubMedPubMedCentralGoogle Scholar
  87. Ron Sender, Shai Fuchs, Ron Milo, (2016) Revised estimates for the number of human and bacteria cells in the body. PLOS Biology 14 (8):e1002533PubMedPubMedCentralCrossRefGoogle Scholar
  88. Rosenberg E, Sharon G, Atad I, Zilber-Rosenberg I (2010) The evolution of animals and plants via symbiosis with microorganisms. Environ Microbiol Rep 2:500–506. CrossRefPubMedGoogle Scholar
  89. Rosenblat JD, Kakar R, Berk M et al (2016) Anti-inflammatory agents in the treatment of bipolar depression: a systematic review and meta-analysis. Bipolar Disord 18:89–101. CrossRefPubMedGoogle Scholar
  90. Roshanaei-Moghaddam B, Katon W (2009) Premature mortality from general medical illnesses among persons with bipolar disorder: a review. Psychiatr Serv 60:147–156PubMedCrossRefPubMedCentralGoogle Scholar
  91. Round JL, Mazmanian SK (2009) The gut microbiota shapes intestinal immune responses during health and disease. Nat Rev Immunol 9:313–323. CrossRefPubMedPubMedCentralGoogle Scholar
  92. Sachs GS, Printz DJ, Kahn DA, Carpenter D, Docherty JP (2000) The expert consensus guideline series: medication treatment of bipolar disorder. Postgrad Med 1:1–104Google Scholar
  93. Sampson TR, Mazmanian SK (2015) Control of brain development, function, and behavior by the microbiome. Cell Host Microbe 17:565–576. CrossRefPubMedPubMedCentralGoogle Scholar
  94. Sánchez-Villegas A, Delgado-Rodríguez M, Alonso A, Schlatter J, Lahortiga F, Majem LS, Martínez-González MA (2009) Association of the Mediterranean dietary pattern with the incidence of depression: the Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN) cohort. Arch Gen Psychiatry 66:1090–1098PubMedCrossRefPubMedCentralGoogle Scholar
  95. Sánchez-Villegas A, Galbete C, Martinez-González MÁ et al (2011) The effect of the Mediterranean diet on plasma brain-derived neurotrophic factor (BDNF) levels: the PREDIMED-NAVARRA randomized trial. Nutr Neurosci 14:195–201PubMedCrossRefPubMedCentralGoogle Scholar
  96. Saraf MK, Piccolo BD, Bowlin AK, Mercer KE, LeRoith T, Chintapalli SV, Shankar K, Badger TM, Yeruva L (2017) Formula diet driven microbiota shifts tryptophan metabolism from serotonin to tryptamine in neonatal porcine colon. Microbiome 5:77. CrossRefPubMedPubMedCentralGoogle Scholar
  97. Sarris J, Logan AC, Akbaraly TN et al (2015a) Nutritional medicine as mainstream in psychiatry. Lancet Psychiatry 2:271–274PubMedCrossRefPubMedCentralGoogle Scholar
  98. Sarris J, Logan AC, Akbaraly TN et al (2015b) International Society for Nutritional Psychiatry Research consensus position statement: nutritional medicine in modern psychiatry. World Psychiatry 14:370–371PubMedPubMedCentralCrossRefGoogle Scholar
  99. Schmidt K, Cowen PJ, Harmer CJ, Tzortzis G, Errington S, Burnet PW (2015) Prebiotic intake reduces the waking cortisol response and alters emotional bias in healthy volunteers. Psychopharmacology 232:1793–1801. CrossRefPubMedPubMedCentralGoogle Scholar
  100. Scholey A (2018) Nutrients for neurocognition in health and disease: measures, methodologies and mechanisms. Proc Nutr Soc 77:73–83PubMedCrossRefPubMedCentralGoogle Scholar
  101. Scott KA, Ida M, Peterson VL et al (2017) Revisiting Metchnikoff: age-related alterations in microbiota-gut-brain axis in the mouse. Brain Behav Immun 65:20–32CrossRefGoogle Scholar
  102. Sender R, Fuchs S, Milo R (2016) Revised estimates for the number of human and bacteria cells in the body. PLOS Biology 14(8): e1002533PubMedPubMedCentralCrossRefGoogle Scholar
  103. Severance EG, Gressitt KL, Stallings CR et al (2013) Discordant patterns of bacterial translocation markers and implications for innate immune imbalances in schizophrenia. Schizophr Res 148:130–137PubMedPubMedCentralCrossRefGoogle Scholar
  104. Severance EG, Yolken RH, Eaton WW (2016) Autoimmune diseases, gastrointestinal disorders and the microbiome in schizophrenia: more than a gut feeling. Schizophr Res 176:23–35PubMedCrossRefPubMedCentralGoogle Scholar
  105. Sokol H, Seksik P, Furet JP et al (2009) Low counts of Faecalibacterium prausnitzii in colitis microbiota. Inflamm Bowel Dis 15:1183–1189. CrossRefPubMedPubMedCentralGoogle Scholar
  106. Steenbergen L, Sellaro R, van Hemert S, Bosch JA, Colzato LS (2015) A randomized controlled trial to test the effect of multispecies probiotics on cognitive reactivity to sad mood. Brain Behav Immun 48:258–264PubMedPubMedCentralCrossRefGoogle Scholar
  107. Sudo N, Chida Y, Aiba Y, Sonoda J, Oyama N, Yu XN, Kubo C, Koga Y (2004) Postnatal microbial colonization programs the hypothalamic–pituitary–adrenal system for stress response in mice. J Physiol 558:263–275PubMedPubMedCentralCrossRefGoogle Scholar
  108. Sun Y, Geng W, Pan Y, Wang J, Xiao P, Wang Y (2019) Supplementation with Lactobacillus kefiranofaciens ZW3 from Tibetan Kefir improves depression-like behavior in stressed mice by modulating the gut microbiota. Food Funct. CrossRefGoogle Scholar
  109. Suppes T, Dennehy EB, Swann AC et al (2002) Report of the Texas Consensus Conference Panel on medication treatment of bipolar disorder 2000. J Clin Psychiatry 63(4):288–299. PubMedCrossRefPubMedCentralGoogle Scholar
  110. Swidsinski A, Loening-Baucke V, Vaneechoutte M, Doerffel Y (2008) Active Crohn’s disease and ulcerative colitis can be specifically diagnosed and monitored based on the biostructure of the fecal flora. Inflamm Bowel Dis 14:147–161. CrossRefPubMedGoogle Scholar
  111. Sylvia LG, Peters AT, Deckersbach T, Nierenberg AA (2013) Nutrient-based therapies for bipolar disorder: a systematic review. Psychother Psychosom 82:10–19PubMedCrossRefGoogle Scholar
  112. Tannock GW, Savage DC (1974) Influences of dietary and environmental stress on microbial populations in the murine gastrointestinal tract. Infect Immun 9:591–598PubMedPubMedCentralGoogle Scholar
  113. Tseng P-T, Zeng B-S, Chen Y-W, Wu M-K, Wu C-K, Lin P-Y (2016) A meta-analysis and systematic review of the comorbidity between irritable bowel syndrome and bipolar disorder. Medicine (Baltimore) 95(33):e4617. PubMedPubMedCentralCrossRefGoogle Scholar
  114. Turnbaugh PJ, Ley RE, Mahowald MA, Magrini V, Mardis ER, Gordon JI (2006) An obesity-associated gut microbiome with increased capacity for energy harvest. Nature 444:1027CrossRefGoogle Scholar
  115. Walker JR, Graff LA, Bernstein CN (2009) Depression and anxiety in inflammatory bowel disease: a review of comorbidity and management. Inflamm Bowel Dis 15:1105–1118. CrossRefPubMedGoogle Scholar
  116. Weinberg DS, Smalley W, Heidelbaugh JJ, Sultan S, Association AG (2014) American Gastroenterological Association Institute guideline on the pharmacological management of irritable bowel syndrome. Gastroenterology 147:1146PubMedCrossRefGoogle Scholar
  117. Wiest R, Garcia-Tsao G (2005) Bacterial translocation (BT) in cirrhosis. Hepatology 41:422–433PubMedCrossRefGoogle Scholar
  118. Wozniak J, Biederman J, Mick E, Waxmonsky J, Hantsoo L, Best C, Cluette-Brown JE, Laposata M (2007) Omega-3 fatty acid monotherapy for pediatric bipolar disorder: a prospective open-label trial. Eur Neuropsychopharmacol 17:440–447PubMedCrossRefGoogle Scholar
  119. Yatham LN (2005) Diagnosis and management of patients with bipolar II disorder. J Clin Psychiatry 66:13–17PubMedGoogle Scholar
  120. Yolken R, Adamos M, Katsafanas E et al (2016) Individuals hospitalized with acute mania have increased exposure to antimicrobial medications. Bipolar Disord 18:404–409PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Shakuntla Gondalia
    • 1
    Email author
  • Lisa Parkinson
    • 1
  • Con Stough
    • 1
  • Andrew Scholey
    • 1
  1. 1.Centre for Human PsychopharmacologySwinburne University of TechnologyHawthornAustralia

Personalised recommendations