Can antibiotics trigger a dip in mental health?

Research has revealed that infections treated by broad-spectrum antibiotics are associated with an increased risk of anxiety and depression. But, what’s the likelihood you may actually experience a mental wobble while on meds?  

It’s 2am and I’m no closer to falling asleep than I am to winning a Nobel Prize. My heart beats so fast Blue Man Group could be performing on my left ventricle, and intrusive thoughts swamp my brain. This isn’t an unfamiliar sensation – I’ve suffered with anxiety and intrusive thoughts for as long as I can remember. It is, however, the first time in a couple of years that I’ve experienced a reaction so significant.

I replay the past 24 hours in my mind, watching it like football highlights, trying to glean what could’ve triggered it. All in all, I’d had a pretty unremarkable day; no drama, I had eaten, and I hadn’t consumed a load of alcohol or caffeine. I put it down to tiredness, cursing my silly brain for being completely counterproductive. Then, I remember that I’m a few days into a short course of antibiotics. 

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Google doesn’t deliver me any concrete answers when I make a cursory search, but it does direct me to a study, published in 2022, which found that infections treated by broad-spectrum antibiotics are associated with an increased risk of anxiety and depression. Curiosity piqued, I need to ask the experts whether antibiotics really do have a negative impact on your mental wellbeing.

What happens in the gut when you take antibiotics?

To understand the possible link, we first have to delve into the gut. Another term for gastrointestinal tract the gut is, essentially, the digestive system – the passageway from mouth to anus, and it oversees several super important functions. 

“The gut microbiome is a diverse population of trillions of bacteria, viruses, fungi and other microbes which live on the lining of the intestine and regulate not only processes such as digestion and absorption of nutrients from food, but also plays a role in our wider health including metabolism, immune system and mental health,” explains Dr Frankie Jackson-Spence, NHS doctor and media medic. 

Having a diverse microbiome, whereby many different species of microbiomes are thriving, is important for supporting these functions. “Diversity is key – that’s why it’s recommended to eat a wide range of plant-based foods each week, as different plant species contain different chemicals which feed the different species in our gut microbiome differently, therefore supporting microbiome diversity.”

We know that the brain and gut are closely connected, so it follows that antibiotics might impact mental wellbeing in some way.

When we introduce antibiotics into the mix to treat infection, this causes disruption to the gut microbiota as the medication attempts to kill off unwanted microbes. “Sometimes as a by-product of this mechanism, some microbiomes in our gut microbiome may also be affected,” Dr Jackson-Spence says. 

“Some antibiotics may kill some species of the gut microbiome, therefore bringing about a decrease in gut microbial diversity, and this is viewed as a risk factor for depression.” That said, it’s important to note that not all antibiotics negatively affect the microbiome.

How are the gut and brain connected?

If you’ve ever experienced a dodgy belly when you feel anxious or nervous, you’ll know that the brain and the gut are connected. This is called the gut-brain axis. “The gut-brain axis is a bidirectional communication system between the gut and the brain,” says Dr Jackson-Spence. “The gut contains nerves that communicate with the brain and the physiological state of the gut lining and microbiome influences how the nerves transmit signals back to the brain. If the gut microbiome diversity is not optimal, it can affect the transmission of signals back to the brain.”

She goes on to explain: “Reduced gut microbiome diversity has been observed in cases of many mental health conditions including, but not limited to, depression, bipolar disorder, schizophrenia and ADHD.”

However, these conditions, are extremely complex and she explains that it would be unusual for the development or worsening of symptoms to be caused by just one factor. It often comes down to a combination of genetics and epigenetics (how your environment influences expression of genes). “For example, two genetically identical twins may grow up and one may develop a mental health condition and the other doesn’t. This is due to environmental and lifestyle differences.”

What does science say about the link between antibiotics and mental wellbeing?

While there is reason to believe that antibiotic use could be associated with a dip in mental wellbeing, there’s currently not much in the way of concrete evidence to say for sure. “Over the last few years there has been an increasing interest in the gut microbiome and more and more research suggests it may be the gatekeeper to our wider health,” Dr Jackson-Spence says. 

“There are a few studies linking antibiotic use with increased rates of anxiety and depression, and whilst it is an interesting area for further research, currently the research is not strong enough to make any conclusive bold claims or solidly prove this link.”

Remember, too, that mental wellbeing is influenced by many factors, including genetic predisposition, sex, socioeconomic status and race, as well as lifestyle factors such as diet, exercise, sleep, stress levels, substance use and other medications. This means that, while you may experience a mental wobble when taking antibiotics, it’s more likely influenced by a combination of factors.

Anxiety can be caused by a host of issues – medication may just be a small part of a larger puzzle.

My own early-hours anxious episode, although I tried my best to find cause to pin the blame on the pills I was taking (because then it would inevitably be over sooner), was probably triggered by more than just my gut microbiome being off (nevertheless, I did dash to my local Sainsbury’s to bulk-buy kefir the following day, just in case). 

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If you’re concerned about your mental wellbeing potentially being impacted by prolonged antibiotics use it’s definitely worth having a discussion with your healthcare provider. But, bear in mind that antibiotics serve a crucial purpose. “Antibiotic stewardship is important for multiple reasons and doctors are trained to prescribe antibiotics only when really necessary,” Dr Jackson-Spence says. “Therefore, if you are advised to take antibiotics for an infection, or to prevent infection, then it’s recommended that you follow medical advice.”

How to take care of your mental wellbeing when you’re on antibiotics

There are many ways to support your mental wellbeing when you’re taking antibiotics (and, of course, when you’re physically well too).

Eat more plants

“For most people, increasing prebiotics in the diet is a good starting point,” says Lucy Kerrison, registered dietician at The Gut Health Clinic. “These are the foods which naturally feed the good bacteria within our gut, helping them to grow and thrive. It includes products such as garlic, onion, pulses and stone fruits.” 

Aim for 30 different types of plant-based foods per week, if you can, to feed the various species of gut microbiome. 

Think about probiotic supplements

“In some cases I would recommend a probiotic supplement, but this should not be a blanket case recommendation for all, as it can take longer for your gut bacteria to recover after antibiotic use, if you are pairing them with probiotics,” Kerrison adds.

Prioritise self-care

You should also prioritise quality sleep, spending time outside, and stress management. Daily exercise helps to support gut microbiome diversity, and making sure that you only take antibiotics as instructed by your doctor is imporant.

Images: Getty

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