The pharmacological action of antidepressants on the gastrointestinal tract and their impact on human microbiota

Resumo

Introduction: Antidepressant medications are frequently used in the treatment of Major Depressive Disorder. Currently, Selective Serotonin Reuptake Inhibitors are the most widely prescribed for its treatment. There is a strong connection between the human intestinal microbiota and the nervous system, with this communication being bidirectional. Therefore, bacteria play roles in processes related to brain physiology, psychology, and behavior. Objective: Thus, the aim of this review is to present the mechanism of action of Selective Serotonin Reuptake Inhibitors in the gastrointestinal tract and their impact on the microbiota. Methods: The review analyzed articles from PubMed, Elsevier, and Cochrane published between 2018 and 2023, using descriptors such as “pharmacology of Selective Serotonin Reuptake Inhibitors,” “gut microbiome,” and “antidepressants.” The inclusion criterion was publications addressing the association between intestinal microbiota and antidepressants in adults. Duplicate articles and dissertations were excluded. A total of 13 articles were selected. Results: Selective Serotonin Reuptake Inhibitors affect the structure of intestinal communities. Sertraline, Fluoxetine, and Paroxetine exhibit greater intensity of antimicrobial action. Considering the impact of Selective Serotonin Reuptake Inhibitors on the intestinal microbiota, it is suggested that this environment has the potential to interfere with the efficacy of treatments by considering the potential for dysbiosis induced by prolonged use. Conclusion: Sertraline, Fluoxetine, and Paroxetine display greater intensity of antimicrobial action in the intestine, with different levels of absorption leading to variability in susceptibility to medications. Research suggests that the impact of Selective Serotonin Reuptake Inhibitors on the intestinal microbiota has the potential to interfere with pharmacological efficacy.