1
|
Brushett S, Gacesa R, Vich Vila A, Brandao Gois M, Andreu-Sánchez S, Swarte J, Klaassen M, Collij V, Sinha T, Bolte L, Wu J, Swertz M, de Kroon M, Reijneveld S, Wijmenga C, Weersma R, Fu J, van Loo H, Kurilshikov A, Zhernakova A. Gut feelings: the relations between depression, anxiety, psychotropic drugs and the gut microbiome. Gut Microbes 2023; 15:2281360. [PMID: 38017662 PMCID: PMC10730195 DOI: 10.1080/19490976.2023.2281360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/06/2023] [Indexed: 11/30/2023] Open
Abstract
The gut microbiome is involved in the bi-directional relationship of the gut - brain axis. As most studies of this relationship are small and do not account for use of psychotropic drugs (PTDs), we explored the relations of the gut microbiome with several internalizing disorders, while adjusting for PTDs and other relevant medications, in 7,656 Lifelines participants from the Northern Netherlands (5,522 controls and 491 participants with at least one internalizing disorder). Disorders included dysthymia, major depressive disorder (MDD), any depressive disorder (AnyDep: dysthymia or MDD), generalized anxiety disorder (GAD) and any anxiety disorder (AnyAnx: GAD, social phobia and panic disorder). Compared to controls, 17 species were associated with depressive disorders and 3 were associated with anxiety disorders. Around 90% of these associations remained significant (FDR <0.05) after adjustment for PTD use, suggesting that the disorders, not PTD use, drove these associations. Negative associations were observed for the butyrate-producing bacteria Ruminococcus bromii in participants with AnyDep and for Bifidobacterium bifidum in AnyAnx participants, along with many others. Tryptophan and glutamate synthesis modules and the 3,4-Dihydroxyphenylacetic acid synthesis module (related to dopamine metabolism) were negatively associated with MDD and/or dysthymia. After additional adjustment for functional gastrointestinal disorders and irritable bowel syndrome, these relations remained either statistically (FDR <0.05) or nominally (P < 0.05) significant. Overall, multiple bacterial species and functional modules were associated with internalizing disorders, including gut - brain relevant components, while associations to PTD use were moderate. These findings suggest that internalizing disorders rather than PTDs are associated with gut microbiome differences relative to controls.
Collapse
Affiliation(s)
- S. Brushett
- Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
- Department of Health Sciences, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - R. Gacesa
- Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - A. Vich Vila
- Department of Microbiology and Immunology, Rega Institute for Medical Research, Leuven, Belgium
- VIB-KU Leuven Center for Microbiology, Leuven, Belgium
| | - M.F. Brandao Gois
- Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - S. Andreu-Sánchez
- Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
- Department of Pediatrics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - J.C. Swarte
- Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - M.A.Y. Klaassen
- Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - V. Collij
- Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - T. Sinha
- Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - L.A. Bolte
- Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - J. Wu
- Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - M. Swertz
- Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
- Genomics Coordination Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M.L.A. de Kroon
- Department of Health Sciences, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - S.A. Reijneveld
- Department of Health Sciences, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - C. Wijmenga
- Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - R.K. Weersma
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - J. Fu
- Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
- Department of Pediatrics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - H.M. van Loo
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A. Kurilshikov
- Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - A. Zhernakova
- Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
2
|
Holz DM, Ewen M, Dreser A, Bautista S, Soria R, van Dijk J, Reijneveld S, Hogerzeil H. Availability, Prices and Affordability of Selected Essential Cancer Medicines in a Middle-Income Country: The Case of Mexico. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.88900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: More alternatives are becoming available for the diagnosis and treatment of cancer in low- and middle-income countries. Yet, because of increasing demands, many governments are now facing the dilemma of making essential cancer medicines available to all while keeping them affordable. Precise information about current access to these medicines is limited, and there's no systematic methodology in place to do so. Aim: To assess the availability and affordability of essential cancer medicines in Mexico, and compare their prices (public sector procurement and patient prices) against those in other countries of the region. Methods: We adapted the WHO/HAI methodology. We surveyed 21 public hospitals and 19 private pharmacies in 8 states of Mexico. Data were collected on the availability and prices of 49 essential cancer medicines (each strength and dose-form specific). Prices were compared against those in Chile, Peru, Brazil, Colombia and PAHO's Strategic Fund. Results: Of the various medicines, mean availability in public and private sector outlets was 61.2% and 67.5%, respectively. In the public sector, medicines covered by the public health insurance “People's Health Insurance” (SPS) were slightly more available. Only 7 (public sector) and 5 (private sector) out of 49 medicines were deemed affordable. Overall, public sector procurement prices were 41% lower than in other countries of the region. Conclusion: The availability of essential cancer medicines, in the public and private sector, falls below WHO's 80% target. The affordability remains suboptimal as well. A national health insurance scheme could serve as a mechanism to improve access to cancer medicines in the public sector. Comprehensive pricing policies are warranted to improve the affordability of cancer medicines in the private sector.
Collapse
Affiliation(s)
- D. Moye Holz
- University of Groningen, University Medical Center Groningen, Department of Community and Occupational Medicine, Groningen, The Netherlands
| | - M. Ewen
- Health Action International, Amsterdam, The Netherlands
| | - A. Dreser
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - S. Bautista
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - R. Soria
- Boston University, School of Public Health, Boston, MA
| | - J. van Dijk
- University of Groningen, University Medical Center Groningen, Department of Community and Occupational Medicine, Groningen, The Netherlands
| | - S. Reijneveld
- University of Groningen, University Medical Center Groningen, Department of Community and Occupational Medicine, Groningen, The Netherlands
| | - H. Hogerzeil
- University of Groningen, University Medical Center Groningen, Department of Community and Occupational Medicine, Groningen, The Netherlands
| |
Collapse
|