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Gut/Brain Axis, Microbiome, Ketamine And More..

G_Chem

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I found all this very interesting and it pertains to the increasing use of ketamine as an antidepressant. I think it’ll be best to cut quotes and talk on them intermittently. They say it a lot better than I will..

“The ‘gut-brain axis’ represents a complex network of pathways interconnecting the gut and the brain, comprising the central nervous system (CNS), the sympathetic and parasympathetic branches of the autonomic nervous system (ANS), the enteric nervous system (ENS), as well as the wide array of cells in the gastrointestinal microenvironment.”

“An exciting emerging issue is that the extension of this microbial influence to the CNS may contribute to the regulation of brain development and behaviour.”

“Tryptophan is an aromatic amino acid containing an indolic group attached to an alanyl side chain. The aminoacid is essential for animals and humans, which prevalently derive it from exogenous sources, such as dietary nutrient intake, and, only in part, from endogenous protein degradation. The main dietary sources of tryptophan are chocolate, cereals milk, milk derivates, red meat, poultry, eggs, fish, and dried fruits.”

“In the gut, the amino acid may be also metabolized, under direct or indirect control by the microbiota, giving origin to several compounds, such as 5-HT, kynurenines, tryptamine, and indolic compounds, which participate in the microbiota-gut-brain communication.”

“Under normal conditions, about 90% of the assumed tryptophan is catabolized and transformed into kynurenine through the kynurenine pathway, while approximately 3% is metabolized into 5-HT, and the remaining is degraded by the gut microbiota to produce indole and its derivatives.”

“…metabolites of the kynurenine pathway, collectively called kynurenines, in particular quinolinic acid and kynurenic acid, may influence neuronal activity both in the CNS and in the periphery, retaining neurotoxic and neuroprotective properties, respectively. In this perspective, an unbalanced kynurenine metabolism has been suggested to underlay development of microbiota-gut-brain axis disorders.”

“Quinolinic acid may act as an excitotoxin both in the peripheral and CNS, due to its agonist properties at ionotropic glutamatergic N-methyl-d-aspartate (NMDA) receptors. Quinolinic acid increases extracellular glutamate levels and acts synergistically with the amino acid to induce NMDA-mediated excitotoxicity.”

“A growing body of evidence suggests that quinolinic acid may participate in the pathophysiology of several psychiatric and neurodegenerative disorders. In contrast, kynurenic acid is considered to be neuroprotective, acting as an antagonist at NMDA receptors both in the CNS and in the ENS.”

“Both in IBS and IBD, changes in the microbial community and in its metabolites participate in dysfunctions of the epithelial, immune, and neuronal gut compartments. It is now assessed that such derangements may not only underlay gut symptoms but may also influence the gut-brain communication, predisposing to CNS disorders. In this scenario, impaired tryptophan metabolism along the microbiota-gut-brain axis may potentially participate in the manifestation of both local and CNS symptoms associated with both diseases.”

“IBS patients may frequently experience high levels of anxiety and depression with respect to healthy subjects, regardless of the IBS subtype. Both psychiatric disorders are closely related to stress, an important pathogenic factor for IBS.”

“From a metabolomic stand point, changes in microbiota composition during chronic stress is associated with the diversion of tryptophan metabolism from the 5-HT to the kynurenine pathway. Administration of the probiotic Lactobacillus reuteri in mice subjected to stress stimuli attenuated the unbalanced tryptophan transformation, reinforcing the concept that the microbiota may influence metabolism and resilience during stress.”

“Interestingly, anxiety-like behaviours developed in mice receiving gut microbiota from depressed patients in parallel with increased blood kynurenine levels and kynurenine/tryptophan ratio.”

“Manifestation of depressive symptoms in IBS patients was correlated with altered tryptophan metabolism.”

“Kynurenine involvement in stress-related disorders may depend on the ability of this molecular pathway to influence NMDA receptors located in CNS regions involved in the development of depression, such as hippocampus, amygdala, and cingulate cortex.”

“In mice, the prodrug, 4-chloro-kynurenic acid, induced a rapid onset of antidepressant effects, displaying a better safety profile than other glutamatergic antagonists already used in clinical settings, such as ketamine, holding promises for use in humans.”

“In the gut, the modulation of the kynurenine pathway in favour of kynurenic acid synthesis may be neuroprotective to compensate for inflammation-induced increased NMDA receptor activity in the neuromuscular compartment.”

“Quinolinic, as a neurotoxic NMDA agonist, has been suggested to participate to depression development. Data from clinical investigations suggest that kynurenic acid/quinolinic acid ratio may represent an index of neuroprotection, and a reduced ratio may be indicative of inflammation-induced depressive disorders.”


“Quinolinic acid…is often implicated in the pathogenesis of a variety of human neurological diseases. QUIN is an agonist of N-methyl-D-aspartate (NMDA) receptor, and it has a high in vivo potency as an excitotoxin.”

“Free radical generation and oxidative stress are involved in the QUIN-induced toxicity; however, we need to take in mind that these mechanisms can be dependent and/or independent of its activity on NMDA receptors. In this line, it has been shown that QUIN can produce oxidative damage independent of its activity under NMDA receptor; this mechanism involves a complex between QUIN and Fe2+.”

“Inflammatory events are also implicated in the QUIN toxicity. It is known that microglia is responsible for inflammatory responses in the CNS and takes the major role in altered levels of QUIN…”

“…large amounts of QUIN are produced and secreted by activated microglia. During CNS inflammation, QUIN levels increase in brain homogenate (246-fold) and extracellular fluid (66-fold).”

“Several reports have been shown that the intrastriatal administration of QUIN in rats produced significant behavioral changes.”

“On the other hand, the few studies in which it has been investigated the cognitive deficits of rats with QUIN lesions have indicated that this metabolite causes deficits in spatial reference memory.”

“Alteration in QUIN levels has been implicated in different pathologies such as Alzheimer's, Huntington's, and Parkinson's diseases..”



GC- Alright that’s enough quotes for a minute. In a nutshell what are these two articles saying?..

The serotonin that our bodies need to function at homeostasis is derived from tryptophan which is more or less produce by microbes in our gut.

With an unbalanced microbiome not only will the metabolic fate of the tryptophan change more in favor of the “kynurenine pathway” but even amongst the kynurenine pathway we see a shift from production of kynurenic acid compounds with pronounced neuroprotective properties to quinolinic acid a neurotoxic metabolite.

There seems to be a correlation with certain gut related illnesses which have their basis in an unbalanced microbiome. IBS being one. There’s a strong correlation between mood disorders and the gut biome.

We see that inflammation and unbalanced biome lead to majorly increased quinolinic acid levels. Quinolinic acid seems correlated with diseases like Alzheimer’s and Huntington’s showing a likely neurodegenerative quality.

Now here’s a few more articles that link regular folks to this quinolinic acid theory of mood disorders and mental dysfunction.

This one shows people with suicidal depression have increased microglial quinolinic acid.


Another linking depression with a unbalanced kynurenic acid/quinolinic acid ratio.


This article showing the link between kynurenic acid/quinolinic acid and major depression and schizophrenia.



Now this last article is of interest and there’s more to corroborate this claim. It seems kynurenic acid seems to be a possible contributor to schizophrenia but positive for depression, quinolinic acid is bad for depression and cognitive function.

This makes sense as kynurenic acid is a potent antagonist of NMDA, and from anecdotal reports of people with schizophrenia using ketamine they don’t mix well.

But… People with major depression, quinolinic acid being an agonist at NMDA this explains why Ketamine is working wonders for this population.


Hopefully I’ve articulated that well. At the end of the day we could treat the symptoms of the problem as is done with ketamine or we can go right to the source. In this case balancing ones microbiome could mean the difference between depression and possible cognitive problems later in life, or not…

In my next post I’d like to discuss more on how one actually goes about that.

-GC
 
I think that the link between microbiome issues and depression is correlative, but I don’t think that microbiome issues are generally the cause of depression.

Depression seems to be far more likely to be caused by trauma, particularly childhood trauma.

And childhood trauma obviously has a very strong correlation with stress, neglect, and even malnutrition. All of which could easily cause microbiome issues due to poor and/or insufficient diet.

The microbiome theory is an easy way out as it allows people to continue to deny how pervasive and widespread child abuse and other trauma is in our current society. But I don’t think that it is very accurate or a particularly good theory.

We know that ketamine is extremely effective at resolving intrusive thoughts, PTSD, panic attacks, and stress in the days following its use. So it calms down the brain and gives the body time to resolve to optimal functioning. It reduces the norepinephrine dumping that is very detrimental to the gastrointestinal system as well as almost every other part of the body.

Occam’s Razor. Look for the simplest answer here.
 
I think that the link between microbiome issues and depression is correlative, but I don’t think that microbiome issues are generally the cause of depression.

Depression seems to be far more likely to be caused by trauma, particularly childhood trauma.

And childhood trauma obviously has a very strong correlation with stress, neglect, and even malnutrition. All of which could easily cause microbiome issues due to poor and/or insufficient diet.

The microbiome theory is an easy way out as it allows people to continue to deny how pervasive and widespread child abuse and other trauma is in our current society. But I don’t think that it is very accurate or a particularly good theory.

We know that ketamine is extremely effective at resolving intrusive thoughts, PTSD, panic attacks, and stress in the days following its use. So it calms down the brain and gives the body time to resolve to optimal functioning. It reduces the norepinephrine dumping that is very detrimental to the gastrointestinal system as well as almost every other part of the body.

Occam’s Razor. Look for the simplest answer here.

It’s cyclical, stress throws off the microbiome, kynurenine pathway becomes more prevalent, poor mood leads to poor lifestyle choices, rinse and repeat. Also the development of our microbiome is happening in our early years, which then sets the tone for how our biome will be for the rest of our lives.

I think you’re separating our physical from our mental, they are intimately intertwined.

Also we can’t look at all “depression,” as depression has many different causes and severities. In this cases of severe depression I’m willing to put my money that gut biome is a major factor at least.

And with Ketamine based on this model, it’s combating quinolinic acids NMDA agonist properties. This would explain Ketamines magical efficacy far more than a decrease of NE. Many pharmaceuticals modulate NE with none of the magic, very few pharmaceuticals are potent NMDA antagonists.

-GC
 
I think you’re separating our physical from our mental, they are intimately intertwined.
Au contraire, I just think that external physical affects the internal mental AND physical which then create a feedback loop between each other rather than the internal physical form directly affecting the internal mental form of its own accord.
 
Au contraire, I just think that external physical affects the internal mental AND physical which then create a feedback loop between each other rather than the internal physical form directly affecting the internal mental form of its own accord.

Ah I see, I think it goes both ways. Some from a feedback and some from internal microbiome issues.

Im willing to bet there’s plenty of folks with untouchable mood disorders that by all accounts had a decent upbringing. It’s as simple as someone given a lot of antibiotics then wipes out the microbial balance, and mood disorders will arise.

All that said, that’s research I need to either dig up later or wait until it actually occurs. As of right now, you could be right. These changes in metabolism could be correlative not causative.

-GC
 
Im willing to bet there’s plenty of folks with untouchable mood disorders that by all accounts had a decent upbringing. It’s as simple as someone given a lot of antibiotics then wipes out the microbial balance, and mood disorders will arise
Agreed. And I think that the microbiome may very well be a factor in many cases (trauma or not) and even the primary cause in rare cases. But I think that it has often been treated as far more causal than it really is in modern popsci.
 
So after reading over this topic one thing that seems to speak loudly, swaying too much in either direction with NMDA and there’s problems. This study speaks to that truth..


“Additionally, impairment of synaptic plasticity (learning) may result not only from neuronal damage per se but may also be a direct consequence of this continuous, non-contingent NMDA receptor activation. Complete NMDA receptor blockade has also been shown to impair neuronal plasticity, thus, both hypo- and hyperactivity of the glutamatergic system leads to dysfunction.”

It seems it’s best not to mess with this system unless absolutely needed.

-GC
 
ive never had childhood trauma but very happy exciting childhood. yet im diagnosed with major suicidal depression. i believe going back to when i was little, happy and careless, brings more depression to me now actually.
 
There are many causes of depression and anxiety. I think for the majority of people experiencing depression, it is related to situational factors, such as a bad relationship, a job that you hate, the inability to make enough money to have the necessities in life without going into out of control debt, etc. In such cases, therapy and/or working to change these circumstances is the solution, but many people, for various reasons, do not do these things (maybe they feel trapped, maybe they think they can't do better, maybe they're a minimum wage employee and do not believe they have any better prospects, etc). As the root causes go unaddressed, it creates a negative feedback loop where the stress/anxiety/depression continue to increase, which makes it even harder to address the issues, and over time, chronic stress leads to actual physical health problems. Unfortunately, many doctors/psychiatrists simply put people on SSRIs or other antidepressant drugs to mask the symptoms, which doesn't do anything to address the underlying reasons for the depression. Nearly everyone will experience depression at some point during our lives, ad for most of us, that depression (or anxiety) should be seen as a sign that we need to take stock of our lives and change the thing(s) that are not working for us.

Childhood trauma is the most profound example of this. A child does not have the ability to deal with an abusive home situation, and tragically, this usually leads to a lifetime of suffering and health problems that is very difficult to surmount, especially the later in life one gets without effective treatment (my girlfriend suffers from this and I hate it so much).

Then there are those who had great childhoods, and for whatever reason, usually around the onset of puberty or by the early 20s, fall into severe clinical depression for seemingly no reason, due to, seemingly, simply an inborn mental imbalance. One of my oldest friends experiences this. I believe he has unipolar depression - it is like bipolar, another inborn mental disorder, except rarely, those on that bipolar spectrum are unipolar, that is, they do not experience alternating [periods of mania and depression, but just one or the other. Sadly for my friend, he has only ever experienced debilitating, suicidal depression. He has told me many times that the only reason he didn't kill himself many years ago is that he doesn't want to hurt his family. He wishes he could die every day. He has tried everything (though I don't think he has tried NMDA antagonist therapy).

I suppose this post is a bit of a tangent to the thread topic. I guess my point is that gut health certainly does appear to play a role in our mental health, but it can go both ways, and I think depression, and anxiety, are more complex than just an interplay between the brain and the gut.
 
I don't want to rain on the parade, but the space of scientific articles is pretty big, and its really hard to read a bunch of papers to piece a larger coherent theory together without testing it. I probably spent an entire year disabusing myself from that approach, and have little to show for it other than cynicism.

As a non-neuroscientist, but somebody who reads general biology literature, I'm concerned that the kyenurine hypothesis is at least out of vogue. The journals (Nature/Cell/Science) generally publish any biological work and aim to put out the hottest shit. The absence of a stream of kyenurine papers makes me think it's not a theory that a lot of labs are currently working on, or at least that there hasn't been a moment of epiphany for the field. fielding

One other aspect is that a lot of these papers are in really low impact, niche journals. That doesn't necessarily mean it's bad science, but it certainly casts doubt (because if a finding is truly impressive, and well executed it will find its way into a better journal).

In general research with primary data is king. However I think it's super important to look at the actual data and check if you think it matches the conclusions made by the papers. So often people publish weak results that are "statistically signficant".

That kyenuric acid / quinolinic acid ratio in depressed patients paper didn't exactly demonstrate a striking effect in Figure 1.

In contrast the "Severe depression is associsted..." paper generally has results that I believe (they also show their statistics in a more transparent manner).


 
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