Efficacy of Sertraline Combined With Intestinal Microecological Therapy in Adolescents With Moderate Depression and Suicidal Ideation and Its Effects on Serum Inflammatory Factors.

BACKGROUND

Adolescents with moderate depression and suicidal ideation constitute a high-risk psychiatric population. Major depressive disorder with suicidal ideation in this age group is a disabling psychiatric disorder. Current selective serotonin reuptake inhibitor treatments are limited by their low efficacy rates (approximately 50%-60%) and delayed onset of action. Informed by the gut-brain axis theory, this study aimed to evaluate the synergistic efficacy and anti-inflammatory mechanisms of sertraline combined with a Bacillus subtilis probiotic preparation in this high-risk population.

METHODS

This retrospective cohort study included 160 adolescents meeting International Classification of Diseases 10th Revision diagnostic criteria were identified and categorised into either monotherapy (sertraline) or combination therapy (sertraline + probiotics) groups. Over a 12-week treatment period, clinical symptoms were assessed using the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale and Beck Scale for Suicide Ideation-Chinese Version, and serum inflammatory factors, namely, interleukin-6 (IL-6), interleukin-1β (IL-1β), tumour necrosis factor-α (TNF-α) and C-reactive protein (CRP) and peripheral blood inflammatory ratios, namely, platelet-to-lymphocyte, neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios, were measured.

RESULTS

The proportion of patients with severe depression was significantly reduced in the combination group (1.25% vs. 7.5%, p = 0.004), and anxiety symptoms showed significant improvement (severe anxiety proportion: 1.25% vs. 11.25%, p = 0.008). Biomarker analysis revealed significantly reduced levels of IL-6 (p = 0.007), IL-1β (p = 0.002), TNF-α (p = 0.005) and CRP (p = 0.001) in the combination group, and IL-6 and CRP showed strong positive correlations with depression scores (r = 0.35-0.39).

CONCLUSIONS

This study confirms that modulating the intestinal smicroecology can enhance antidepressant efficacy by reducing neuroinflammation.