Probiotics and Prebiotics for Controlling Irritability Due to ADHD and BPD

A pioneering study by the Psychiatry, Mental Health and Addiction Group of the Vall d’Hebron Research Institute (VHIR) and the CIBER for Mental Health (CIBERSAM) has shown that synbiotics (a mixture of probiotics and prebiotics) are a promising alternative to irritability in adults with attention deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD). The results were published in the journal Brain, Behavior and Immunity.

Irritability is a complex and persistent symptom that significantly impacts the quality of life of patients with ADHD and BPD. In severe cases, the condition can even increase the risk of suicide. “Current treatments cannot significantly improve the symptoms of irritability, which often occur alongside other emotional problems such as emotional dysregulation and impulsivity,” he notes. Gara Arteaga Henriques, member of the Psychiatric Service at the Vall d’Hebron University Hospital and researcher in the Psychiatry, Mental Health and Addictions Group of VHIR and CIBERSAM..

Previous studies have shown the ability of synbiotics to treat emotional dysregulation associated with ADHD. Against this background, the team conducted an innovative clinical trial to examine the benefits of synbiotics in treating irritability. The study involved patients from the University Hospital Vall d’Hebron, Semmelweis University in Budapest, Hungary, and Goethe University Hospital in Frankfurt, Germany. The study included 180 patients aged 20 to 65 years, of whom 113 had ADHD, 44 had BPD, and 23 were diagnosed with both conditions.

All of them had symptoms of irritability, and most of them were already undergoing other treatments. The participants were divided into two groups: one received a placebo, and the other a synbiotic. This synbiotic consisted of a mixture of four types of bacteria (probiotics) and a set of sugars that serve as nutrients for the bacteria to grow (prebiotics).

Response to treatment

The research team assessed the effectiveness of the treatment after 10 weeks. A good response was defined as a clinical improvement in irritability symptoms, both from the perspective of healthcare professionals and from the perspective of patients. The results showed that irritability levels had decreased in 19 patients (11 percent of the total): 15 of them (79 percent) received the synbiotic, and only 4 (21 percent) received the placebo. In any case, The treatment was well tolerated, side effects were minimal..

The research team assessed the effectiveness of the treatment after 10 weeks. A good response was defined as a clinical improvement in irritability symptoms, both from the perspective of healthcare professionals and from the perspective of patients. The results showed that irritability levels had decreased in 19 patients (11 percent of the total): 15 of them (79 percent) received the synbiotic, and only 4 (21 percent) received the placebo. In any case, The treatment was well tolerated, side effects were minimal.

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In addition, synbiotics have been shown to useful for other symptomssuch as mood swings, difficulty regulating emotional responses, problems concentrating, and high stress levels. According to Arteaga, “This study provides promising preliminary data on the use of synbiotics to treat irritability and other emotional symptoms in adults with ADHD and BPD.”

Analysis of inflammatory molecules

To understand why some patients respond to synbiotics and others do not, the study looked at the relationship between levels of certain immune system molecules in the blood and the effectiveness of therapy. “We believe that synbiotics may act as immune system regulators and that the response to these treatments depends on each individual’s underlying inflammatory conditions.”— says Arteaga. Among the molecules studied, one stands out RANK-Las the results showed that patients with low levels responded better to treatment with synbiotics. “It appears that when RANK-L levels in the blood are low, there is more severe inflammation that can affect the brain. In these cases, synbiotics may help reduce inflammation and therefore improve symptoms, the expert adds.

The authors highlight the need for further research to confirm these findings and further explore the mechanisms underlying these benefits. “These findings open the door to new possibilities for personalized treatment based on gut microbiota modulation for patients who do not respond to traditional treatments for irritability,” says J.Ocep Antoni Ramos Quiroga, Head of the Psychiatry Service at the Vall d’Hebron University Hospital and the Psychiatry, Mental Health and Addictions Group of the VHIR and CIBERSAM researcher

who explains that “our ultimate goal is that, based on a blood test in which we measure levels of inflammatory molecules, we can determine whether a synbiotic will be effective and offer an additional and complementary therapeutic option to existing treatments.”

Unlike other studies, the results of this study include both clinical assessments by health care professionals, such as patient self-assessments. In order to consider a person as responding to treatment, both assessments must match. “This method provides a more complete and reliable assessment of the response to treatment, avoids errors, and gives a more accurate picture of the effectiveness of the synbiotic,” concludes Arteaga.

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