Changes in the gut microbiome associated with infliximab in patients with bipolar disorder

Brain Behav. 2021 Aug;11(8):e2259. doi: 10.1002/brb3.2259. Epub 2021 Jun 21.


Objectives: Available information exists supporting the gut-brain axis, but additional information is needed to explore how the gut microbiome changes when exposed to mood disorder treatments. We sought to explore the effects of a novel treatment for bipolar disorder (BD), infliximab, on the gut microbiome.

Methods: Participants with a primary diagnosis of BD (n = 15) who participated in a 12-week, randomized placebo-controlled trial evaluating the efficacy of adjunctive infliximab in the treatment of BD were recruited and followed. Stool samples were collected prior to randomization and at 12 weeks. 16S rRNA sequencing was employed in order to analyze the gut microbial community profile.

Results: A total of 17 participants were randomized to infliximab (n = 9; mean [SD] age, 47.6 [10.3] years; 8 female) or to placebo (n = 8; mean [SD] age, 45.9 [10.7] years; 7 female) but two participants from the infliximab group were lost to follow-up post randomization. Across all time points, there were no differences in the diversity on either Shannon or Simpson's Diversity indices. Comparison of Aitchison distances revealed a lack of clustering of the microbiota by time point, but did reveal a small overall effect of treatment that was not significantly different at individual time points. There were also no effects of either time or treatment on differential abundance at either the amplicon sequence variant or genus level.

Conclusions: These observations indicate that no community-wide changes in the microbiota diversity and profile were detected after the use of infliximab treatment.

Keywords: 16S rRNA sequencing; bipolar disorder; gut microbiota; inflammation; infliximab.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Bipolar Disorder* / drug therapy
  • Cluster Analysis
  • Female
  • Gastrointestinal Microbiome*
  • Humans
  • Infliximab
  • Middle Aged
  • RNA, Ribosomal, 16S / genetics


  • RNA, Ribosomal, 16S
  • Infliximab