A case report looking at the effects of faecal microbiota transplantation in a patient with bipolar disorder

To the Editor

It was with interest that I read the article by Green et al. (2019), Faecal microbiota transplants for depression – Who gives a capsule, published in the August 2019 edition of the Royal Australian and New Zealand Journal of Psychiatry.

Here, I present a case report looking at the effects of faecal microbiota transplantation (FMT) in patient J, who suffered with bipolar disorder. She was 29 years in 2012 when she presented to me. She fulfilled the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) diagnostic criteria for bipolar I disorder. She had 10 admissions to hospitals in the public sector when in depressed, manic and psychotic phases.

J had been treated with a number of psychotropic medications including lithium, lamotrigine, sodium valproate, quetiapine, olanzapine, aripiprazole, periciazine, paroxetine, sertraline, venlafaxine, mirtazapine and several benzodiazepines. During her treatment with these psychotropic medications, she experienced considerable weight gain, and she reported that medication did not give her any quality of life or level of functioning.

In 2016, as a matter of interest I spoke to J about the brain-gut microbiome axis and various research pertaining to this, including how a faecal transplant from a healthy mouse made a ‘depressed’ mouse well (Xie, 2017). Around the same time, J and her partner, A had been researching FMT. Later that year, J informed me that she was going to go ahead with FMT using the faeces from her husband who has no history of psychiatric illness and who is of slim build.

I agreed to monitor her condition and later on supervise her coming off her psychotropic medications, which at that time were lithium carbonate 750 mg BD, lamotrigine 200 mg nocte and quetiapine 100 mg nocte. I warned her of the significant risk of relapse.

She had nine FMT treatments over a period of 11 months. Within 6 months of doing FMT, she was symptom free from depression. She has not been depressed since March 2017 or been manic since September 2017. She has remained symptom free, is no longer on medication and has lost 33 kg in weight. I speculate that her weight loss may be due to her changed microbiome, as well as her having stopped taking psychotropic medication. J went from being functionally disabled to running a small business and has published two books.