Cited by 69Gut microbiota and healthTryptophan and brain disordersTreatment of Major Depression

Antibiotics and mental health: the good, the bad and the ugly

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Dinan, Katherine, Dinan, Timothy·2022·Journal of Internal Medicine

Abstract

Antibiotics are recognised as, on occasion, producing psychiatric side effects, most notably depression and anxiety. Apart from antimicrobial activity, antibiotics have multiple off-target effects. The brain-gut-microbiota axis has multiple sites for off-target activity, which may produce either positive or negative antibiotic effects. Here we review how antibiotics impact mental health by acting through the brain-gut-microbiota axis. Microbes in the gut influence brain function by acting through the vagus nerve or by altering the production of short-chain fatty acids or the amino acid tryptophan, the building block of serotonin. Not all antimicrobial actions of antibiotics have a negative impact. The first antidepressant discovered was actually an antibiotic: isoniazid is an antibacterial drug developed for treating tuberculosis. Minocycline, which enters the brain and mediates its effects through microglia, shows antidepressant activity. Some antibiotics bring about a significant decrease in gut microbial diversity, and this is viewed as a risk factor for depression. Other risk factors induced by antibiotics include altered gut barrier function, activation of the hypothalamic-pituitary-adrenal axis, reducing levels of brain-derived neurotrophic factor or oxytocin and alteration of vagal tone. Although most patients taking antibiotics do not suffer from an iatrogenic psychiatric disorder, some do. As clinicians, we need to keep this in mind. The development of new antibiotics is primarily focused on antibiotic resistance, but efforts should be made to reduce off-target brain-gut-microbiota effects resulting in mental health problems.

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  • The microbiota-gut-brain axis has multiple sites for off-target activity, which may lead to positive or negative neurocognitive effects downstream.

    “Certainly, the MGB axis has multiple sites for off-target activity, which may lead to positive or negative neurocognitive effects downstream, emphasizing the importance of antibiotic stewardship (404–407).”

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  1. [75]Beiglbock W, Clotten R. Penicillin as stimulant of the pituitary–adrenal system. Klin Wochenschr. 1952; 30(5‐6): 126– 8. 14939684

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Authors
Dinan, K., & Dinan, T.
Affiliations
  • Trinity College Dublin (IE)
  • University College Cork (IE)
Corresponding author
Dinan, Timothy
Venue
Journal of Internal Medicine
Publisher
Wiley
Published
2022-07-12
Volume
292
Issue
6
Pages
858-869
ISSN
  • 0954-6820 (ISSN-L)
  • 1365-2796
OpenAlex
W4285040840
Cited by
69
References
114
Citations by year
2026: 11 · 2025: 15 · 2024: 22 · 2023: 13 · 2022: 8
FWCI
1.51
Type
journal article
Language
en
Open access
Locations
  • Journal of Internal Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion, cc-by)
Funders
Science Foundation Ireland (SFI/12/RC/2273)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
  • Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
antibiotics, mental health, brain-gut-microbiota axis, depression, anxiety, psychiatric adverse effects, vagus nerve, short-chain fatty acids, tryptophan, serotonin, isoniazid, minocycline, microglia, gut microbiota diversity, intestinal barrier, hypothalamic-pituitary-adrenal axis, brain-derived neurotrophic factor, oxytocin, vagal tone
MeSH terms
Anti-Bacterial Agents, Antidepressive Agents, Brain, Humans, Hypothalamo-Hypophyseal System, Mental Health, Pituitary-Adrenal System

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