Managing mood and mental health: time for new approaches?
The promise of targeting our guts
Mental health issues have been around for a while, meaning that treatment options are also well established. You’ve got lifestyle changes, talking therapies (like cognitive behavioural therapy or acceptance commitment therapy), and medical interventions like selective serotonin reuptake inhibitors (SSRIs) which are used to treat depression. Everyone has heard of these, and they are often referred to as the ‘gold standard’ for treating related issues. Given this, it might seem strange to be writing about developing new approaches. However, a closer look at the options suggests there is a need for innovation. Let’s unpack.
Lifestyle changes
As we discussed in our intro blogs on depression and anxiety, many lifestyle elements contribute to mental health and mood disorders. These include low exercise, poor diet, excessive use of social media, and little social support. However, these same factors can be targeted to improve mental health and often form part of a holistic approach to improving wellbeing.
However, it’s not all plain sailing. If people have unhealthy lifestyles in the first place, there’s often a reason. So often the biggest issue with these approaches is that lifestyles are hard to change and maintain. Anyone else had the same exercise-related new year’s resolution five years in a row? This is especially the case for people who are struggling with mental illness and low mood. The energy and motivation to get up and go for a run or cook something healthy might simply not be there.
Talking therapies
Another common course of action is to see a therapist and many people do find this helpful. The research evidence is mixed though. One of the most well researched therapies is cognitive behavioural therapy (CBT). A review of over 100 studies done a few years ago concluded: “CBT is probably effective in the treatment of [common mental health disorders]; and that the effects are large when the control condition is waiting list, but small to moderate when it is care‐as‐usual or pill placebo”. In other words, when compared to doing nothing, CBT led to a larger drop in symptoms. However, when compared to something else (even a placebo pill), the effect of therapy on symptoms was less meaningful. A more recent review looked at over 400 studies and compared CBT to taking medication and found it to be just as effective in the short term and more effective than medication in the long term (more on the effectiveness of medication below). It’s difficult to know what drives these differences, studies use different participants, different ways of assessing mental health, and often different versions of CBT. There is a general tendency to trust more recent and larger reviews as they benefit from improved quality and quantity of research.
Even if we accept that therapy like CBT can be effective at improving mental health, a very common challenge is that going to therapy is not for everyone. Opening up about sensitive issues can be uncomfortable. Finding a trusted therapist is often half the challenge. There is also still a stigma around mental health issue which may put off some people from seeking care, especially with men. Ultimately this leads to a huge proportion of people with mental health issues, not seeking or completing their treatment. Mental health charity Mind estimates that only 1 in 3 people with mental health challenges seeks treatment. According to government statistics, of the 1.76m people referred to therapy during 2022/23, only 55% completed the full course. In combination, these numbers suggest that roughly 1 in 6 people with mental health challenges actually get a full ‘dose’ of therapy. While increasing the availability of therapy is important to combat the growing mental health epidemic, it’s unlikely to be a silver bullet for the issue.
Medicative approaches
Like therapy, another common option for managing mental health and mood is medication. In the UK alone, over 8 million people are on antidepressants. A quarter of those have been on them for over five years. While many studies have showed medication to be a useful tool in improving mood, there are also many studies that show limited or no improvements compared to standard alternatives. One review, found that medication brought about small improvements, equal to “approximately 10% more reduction of symptoms”. However, the authors suggested this may be underestimating the effect in the real world vs. a research study. A second review (published in one of the world’s leading medical journals) also found similar findings. A third review set a higher bar for what it deemed ‘meaningful’ impact and concluded that “antidepressants seem to have minimal beneficial effects on depressive symptoms and increase the risk of both serious and non-serious adverse events.” Again, it seems that there is some debate about whether medication is the right approach for all.
You might think it’s worth giving it a shot and if it works, great. The challenge is that one typically has to be on the medication for several weeks to start noticing the effect and even if it does work, the medication can bring on serious side effects. Some of these include loss of sexual drive, decreased alertness, headaches, nausea and even suicidal feelings. It is quite common for those struggling with mental health issues to hold off taking medication unless they’ve tried all other approaches.
To sum up the existing approaches…
There’s no doubt that what we’ve been using so far has been helpful and many have benefitted. At the same time, it’s also clear that there is room for improvement. Whether it’s the motivation needed to change lifestyle, the discomfort of talking therapies, or the side effects of medication, the existing options do have down sides. The frightening pace at which the burden of mood disorders is growing demonstrates we need new options.
A new approach: could gut health open up new treatment options for mental health?
A few years ago, scientists discovered the gut microbiome, a collection of microorganisms with hundreds of species of bacteria which influence our health in huge ways. Through the gut-brain-axis (the pathway that connects the brain and the gut), these gut bacteria can also influence our mental health. This exciting new discovery has triggered a huge amount of research into gut-based options for improving mental health.
One avenue this research has explored is the potential for science-driven, high quality, targeted probiotics (i.e. bacteria in a pill) to optimise the gut microbiome from a mental health perspective. The appeal is obvious. Taking probiotics is straight forward and easy. It doesn’t involve deep conversations or the struggle of changing habits. Side effects are also likely to be limited.
There is a steady stream of research exploring this possibility. One review found that probiotics can moderately improve symptoms of depression (roughly similar to the effect of antidepressants). There is also research that shows that taking probiotics with antidepressants improves the medications effect. While the research is still in early days, the potential is clear. It is this emerging science that we are using to build Mibio.
This new line of thinking means that there may be remedies for mood issues that are easier than lifestyle changes, less intimidating than therapy, and with fewer side effects compared to medication. It’s worth saying straight off the bat, we’re not suggesting that diet or supplementation replaces any other form of treatment, but that it can be a quick and easy add-on or starting point that can generate meaningful results. Check out our website if you want to learn more about what we’re up to!