POO for a New You

Two Australian patients with bipolar disorder were treated with fecal microbiota transplantation (FMT). Yes, that means transplanting poop! Their symptoms improved so much that they were able to stop their medications. Now studies with larger numbers of patients and control subjects are beginning to try and determine if changing the gut microbiome is a viable treatment option for those with bipolar disorder.

Bipolar disorder used to be called manic-depressive illness or manic depression. It is a mental illness that features unusual and drastic shifts in mood, energy, activity levels, and concentration that can affect the ability to carry out normal day-to-day tasks. There are three major types of bipolar disorder: Type I, Type II and Cyclothymic Disorder or Cyclothymia. Bipolar disorder is usually diagnosed in late adolescence or early adulthood, or sometimes after pregnancy. The illness requires a lifetime of treatment with a combination of medication and psychotherapy to manage the symptoms.

FMT is an ancient idea. In the fourth century, a Chinese innovator made a concoction called "Yellow Soup" to treat food poisoning or diarrhea. It is not surprising that people did not want to drink the fecal slurry. By the 17th century, veterinarians used oral dosing or enemas to administer FMT therapies to animals. In 1958, a scientist used FMT to successfully treat antibiotic induced diarrhea. It wasn't until 1978, that FMT was found to cure patients of C. diff resistant diarrhea. Scientists are now exploring using FMT to restore the gut microbiome to treat illnesses like Crohn's disease, ulcerative colitis, Parkinson's and MS.

One patient was a woman in her late 20's with bipolar I who was taking a variety of psychotropic drugs. The drugs were not working well for her and they resulted in multiple side effects including weight gain. She was given nine FMT treatments over eleven months and within six months after treatment, she was symptom-free and no longer needed her medications. Months later, she had lost the weight, returned to work and she still remains symptom free.

The second patient began exhibiting symptoms of mental illness at age 10 which worsened by age 15 when he was given the diagnosis of bipolar II disorder. He was on various drugs to control his symptoms. He also experienced serious side effects from some of the medications as well as weight gain that limited his therapy. About a year before FMT treatment, he tried probiotics and found that some helped control his bipolar symptoms. He began reading about microbiome research and decided to try FMT. After 12 months he had virtually no symptoms of bipolar disorder.

The second report of FMT successfully treating bipolar disorder encouraged larger, more thorough studies of FMT treatment. In one Canadian randomized controlled trial of two active FMT treatments for managing bipolar disorder, the researchers will collect food diaries and extensively study the participants' bodies and microbiomes. This and other studies will figure out how to achieve the best results for bipolar disorder patients. Could FMT actually cure bipolar disorder? Let us hope so.