Probiotics

CAM (neuroprotective; synthesize neurotransmitters; reduce inflammation; improve metabolic health; vasal-vagal nerve signaling)

  • Major Depression1 (particularly inflammatory or anxious, improves cognition in depression)
  • Generalized Anxiety1
  • Bipolar Depression2
  • Borderline Personality3
  • SE-weight loss, sexual function on SSRIs3
  • Autism2
  • ADHD3
  • Cognition2
  • Schizophrenia negative symptoms1
  • Deepens sleep
  • Long COVID1

Features

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Handout

Dosing

1 daily

Management

Well-tolerated, low risk. Avoid in HIV or immunocompromised.

We don’t know which dose/strains are best, so recommend patients get one with a variety of strains that have evidence behind them. They should increase intake of prebiotics (the foods probiotics eat, like fiber, vegetables, fruits, fish, nuts; aim for 30 gm fiber a day; see www.chrisaikenmd.com/probioticdiet). In weight loss studies, they only worked when taken with prebiotic (eg fiber supplements, or the brands we recommend have prebiotics in them – called a symbiotic).

EMR Text

Depression

Probiotics used based on randomized controlled trials in depression, including trials in treatment resistant depression, antidepressant augmentation, and cognitive and anxious features of depression (Sulaiman NNY et al, Nutr Neurosci. 2025:1-21).

Anxiety

Probiotics used based on randomized controlled trials in anxiety.

ADHD

Probiotics used based on randomized controlled trials in ADHD (Elhossiny RM, et al, BMC Psychiatry. 2023 ;23(1):823).

Autism

Probiotics used based on randomized controlled trials in autism (Narula Khanna H et al, BMJ Paediatr Open. 2025;9(1):e003045).

Borderline

Probiotics used based on a randomized controlled trial where they improved irritability, lability in borderline personality disorder (Arteaga-Henríquez G et al, Brain Behav Immun. 2024 Aug;120:360-371).

Sleep

Probiotics used based on a randomized controlled trial where they improved sleep quality and mood in patients with insomnia (Liu Y et al, Front Microbiol. 2025;16:1596990).

Cognition

Probiotics used based on a randomized controlled trial where they improved cognition in various populations including depression, stress, older age, and early dementia (Liu X et al, Nutr Rev. 2025;83(11):2144-2158).

Sexual function on SSRIs

Probiotics used based on randomized controlled trial where it improved sexual function and depressive symptoms on SSRIs (Hashemi-Mohammadabad N et al, BMC Psychiatry 2024;24(1):44).

Schizophrenia negative symptoms

Probiotics used based on randomized controlled trials where they improved negative symptoms of schizophrenia.

Antipsychotic weight

Probiotics used based on randomized controlled trials where they reduced weight and metabolic side effects of antipsychotics.

Long COVID

Probiotics recommended based on a randomized controlled trial in long COVID, where it improved fatigue and post-exercise malaise (Ranisavljev M et al, Eur J Nutr. 2024;64(1):28).

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