This a brief post about a recently published paper that found depression, widowhood, living alone and the use of certain anti-depressant drugs were all highly associated with the risk of developing a Clostridium difficile (C. diff.) infection. C. diff. is estimated to cause 7,000 deaths annually in the United States and is prevalent in hospitals throughout Europe. You can read a popular summation of the study here or download the actual paper here.

That widowhood and loneliness predict future cases of C. diff. is not surprising. Stress is a killer precisely because it’s so very damaging to beneficial gut flora populations and gut-barrier function.

Nor am I surprised that the depressed are at increased risk of developing this type of gut dysbiosis. As I wrote in my post on endotoxemia and depression, there is very credible evidence that mental disorders like debilitating depression and anxiety have their basis in disordered gut flora and the inflammation that results from that.

As I’m fond of saying, there can be no complete understanding of human health, including mental health, without referring to gut flora. Not only do emotions affect the health of the gut, the state of the gut affects emotional well-being. Neither can be separated from the other.

What disturbs me most about this paper was the increased association seen between those who went on to develop C. diff. infections and the taking of certain anti-depressant drugs: mirtazapine (Remeron®, Remeron Soltab®), fluoxetine (Prozac®, Sarafem®) and trazodone (Oleptro®).

For each dose of mirtazapine given, there was an 8% increase in the odds of testing positive for C. diff. For each dose of fluoxetine taken, C. diff. risk increased by 6%. For those patients receiving a combination of mirtazapine and trazodone, risk of C. diff. infections was 5.72 times higher than for patients receiving neither.

Much of the medical profession is flying blind as to how a variety of prescribed drugs impact gut health as drugs are never tested for their effects on our microbial populations. Even to this day, we remain largely ignorant of the long-term impacts and shifts to gut flora populations from commonly prescribed antibiotics.

That certain anti-depressants may actually be adding to the problem for individuals already battling gut dysbiosis makes me extremely nervous, especially as Prozac® is approved for use in children. If you or your child are currently on one of these medications, you may want to discuss switching to another anti-depressant with your doctor as a precaution. And as always, concentrate on maintaining beneficial gut flora populations to prevent ever having to deal with this potentially deadly form of dysbiosis.

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