Rol de la disbiosis intestinal en la génesis del trastorno depresivo: evidencia actual

Abstract

El trastorno depresivo mayor (TDM) es una condición psiquiátrica prevalente y debilitante con múltiples mecanismos fisiopatológicos aun en estudio. Entre estos, la disbiosis intestinal ha emergido como un factor relevante al alterar el equilibrio microbiano necesario para la producción de neurotransmisores, la integridad de barreras biológicas y la regulación inflamatoria. Objetivo: evaluar la relación entre la disbiosis intestinal y el TDM, así como la exploración del impacto de intervenciones basadas en la modulación de la microbiota, como probióticos, prebióticos y trasplante fecal. Diseño: el estudio se realizó conforme a la declaración PRISMA, analizando 56 estudios publicados entre 2015 y 2023. Resultados: la disbiosis está asociada con una reducción en géneros bacterianos productores de ácidos grasos de cadena corta, un aumento de citocinas proinflamatorias y alteraciones en la producción de neurotransmisores clave, tales como serotonina y GABA. Por otra parte, intervenciones como los probióticos y prebióticos mostraron resultados prometedores al mejorar la inflamación y los síntomas depresivos, aunque se requieren estudios más sólidos para validar estas observaciones. Conclusiones: la disbiosis intestinal influye en la fisiopatología del TDM a través del eje microbiota-intestino-cerebro, por lo tanto, destaca su potencial como objetivo terapéutico. Este estudio refuerza la importancia de estrategias integradoras para el manejo del TDM, combinando enfoques farmacológicos y moduladores de la microbiota.

Major depressive disorder (MDD) is a highly prevalent and disabling psychiatric condition with complex and multifactorial pathophysiology. Among emerging factors, gut dysbiosis has been highlighted for its role in disrupting the microbial balance essential for neurotransmitter production, barrier integrity, and inflammatory regulation. Objectives: This systematic review aimed to evaluate the relationship between gut dysbiosis and MDD, while exploring the impact of microbiota-modulating interventions, such as probiotics, prebiotics, and fecal microbiota transplantation (FMT). Methods: Following PRISMA guidelines, 56 studies published between 2015 and 2023 were included. Results: There is significant association between dysbiosis and reduced levels of short-chain fatty acid-producing bacteria, increased pro-inflammatory cytokines, and altered neurotransmitter synthesis, including serotonin and GABA. Interventions like probiotics and prebiotics demonstrated promising results in reducing inflammation and improving depressiveMajor depressive disorder (MDD) is a highly prevalent and disabling psychiatric condition with complex and multifactorial pathophysiology. Among emerging factors, gut dysbiosis has been highlighted for its role in disrupting the microbial balance essential for neurotransmitter production, barrier integrity, and inflammatory regulation. Objectives: This systematic review aimed to evaluate the relationship between gut dysbiosis and MDD, while exploring the impact of microbiota-modulating interventions, such as probiotics, prebiotics, and fecal microbiota transplantation (FMT). Methods: Following PRISMA guidelines, 56 studies published between 2015 and 2023 were included. Results: There is significant association between dysbiosis and reduced levels of short-chain fatty acid-producing bacteria, increased pro-inflammatory cytokines, and altered neurotransmitter synthesis, including serotonin and GABA. Interventions like probiotics and prebiotics demonstrated promising results in reducing inflammation and improving depressive symptoms, although further robust studies are necessary to confirm their efficacy. Conclusions: gut dysbiosis plays a critical role in the pathophysiology of MDD through the gut-brain axis, underscoring its therapeutic potential. This study highlights the importance of integrated strategies that combine pharmacological and microbiota-targeted approaches for the management of MDD. symptoms, although further robust studies are necessary to confirm their efficacy. Conclusions: gut dysbiosis plays a critical role in the pathophysiology of MDD through the gut-brain axis, underscoring its therapeutic potential. This study highlights the importance of integrated strategies that combine pharmacological and microbiota-targeted approaches for the management of MDD.