Effect of Probiotics "Psychobiotics" on Depression and Metabolic Syndrome in Saudi Arabia

NCT06765057 | Recruiting Phase 2 DMC

• 1 other identifier: E-23-7867
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this clinical trial is to assess the effect of commercial multi-strains psychobiotics supplementation as an ad-on therapy on depressive symptoms and metabolic syndrome components (HDL-C, FPG, TGs, WC, BP) in adult depressed patients with pre-metabolic syndrome and metabolic syndrome. The second goal is to explore the effect of commercial multi-strains psychobiotics supplementation on the anthropometric measurement (weight, body mass index (BMI)) in adult depressed patients with pre-metabolic syndrome and metabolic syndrome. The main questions they aim to answer are:

• Will commercial multi-strains psychobiotics supplementation help to ease depressive symptoms as an ad-on therapy in patients with pre-metabolic syndrome and metabolic syndrome?
• Will commercial multi-strains psychobiotics supplementation improve anthropometric measurements and metabolic syndrome components (WC, FPG, BP, TGs, HDL-C) in depressed patients? Researchers will compare psychobiotics to a placebo (a look-alike substance that contains no drug) to see if psychobiotics work to improve depression and metabolic syndrome components. Participants will:
• Be examined for depression, anxiety, and metabolic syndrome components (waist circumference, diabetes, blood pressure, triglycerides, and high-density lipoprotein).
• Be asked to conduct laboratory tests to determine the inclusion and exclusion criteria.
• Be given probiotics/ placebo to consume every day for 3 months (12 weeks).
• Repeat the examination and laboratory tests to determine the results.
• Be followed up weekly for adverse events and to insure their compliance with the study instructions.
• Be followed up after 4 weeks as an end-visit and will conduct the examination and the laboratory blood tests.

Conditions

Depression Anxiety Disorder

Outcome Measures

Primary Outcomes (7)

• Psychological Assessment (depression1)

  • Depression will be diagnosed clinically using the validated Arabic translated Patient Health Questionary 9 (PHQ-9) in Saudi population to assess the severity of depression as a self-report scale for patients in both groups. The minimum score is 0 while the maximum score is 27; the higher the score the more severe the depression is. Scores 0-4 means no depression; scores 5-9 means mild depression; scores 10-14 means moderate depression; score 15-19 means moderately severe, and 20-27 means severe depression.

  at baseline, after the end of the 12th week of the intervention, and after 4 weeks post-intervention follow-up (end visit).

• Psychological Assessment (depression2)

  • Hamilton Depression Rating Scale (HDRS) will be also used as a clinician-rated scale to evaluate the severity of depression symptoms. The most commonly used versions in are either a 17- or a 21-item scale, but this study uses the 21-item scale. The scoring of the severity of the depressive symptoms is based on 17 items. It is scored between 0 (not present) and 4 (severe) points using either a three-point or a five-point scale and summed up to obtain the total score. Scores 0-7 represent the absence or remission of depression; scores between 8-16 represent mild depression; scores between 17-23 represent moderate depression, and scores equal to 24 and above represent severe depression.

  at baseline, after the end of the 12th week of the intervention, and after 4 weeks post-intervention follow-up (end visit).

• Psychological Assessment (Anxiety)

  • Generalized Anxiety Disorder-7 (GAD-7) scale will be added to assess anxiety. Each of the 7 items is scored from 0 to 3, the GAD-7 scale score ranges from 0 to 21; the higher the score the more severe the anxiety is. Scores 0-4 means no anxiety; scores 5-9 means mild anxiety; scores 10-14 means moderate anxiety; score 15-21 means severe anxiety.

  at baseline, after the end of the 12th week of the intervention, and after 4 weeks post-intervention follow-up (end visit).

• Anthropometric Measurements

  Height and weight will be combined to calculate the body mass index (BMI). BMI will be measured through dividing individual's weight in kilograms by height in square meter. Lower than 18.5 means underweight; 18.5 to lower than or equal 25 means normal weight; 25.0 to lower than or equal 30 means overweight; 30.0 or above means obese (Centers for Disease Control and Prevention (CDC), 2020).

  at baseline, after the end of the 12th week of the intervention, and after 4 weeks post-intervention follow-up (end visit).

• Metabolic Syndrome Components (Waist circumference)

  Central obesity will be measured through waist circumference (WC) by placing non-stretchable meter around the waist above the bone of the hip equally; the tape should be tightened lightly without pressure on skin (Whitney \& Rolfes, 2020). WC for men is ≥ 94 centimeters while for women ≥ 80 centimeters (Alberti, Zimmet, \& Shaw, 2006).

  at baseline, after the end of the 12th week of the intervention, and after 4 weeks post-intervention follow-up (end visit).

• Metabolic Syndrome Components (Medical Assessments/ Laboratory Tests)

  Blood samples will be collected out on venous blood after fasting for 12 h. Blood samples in each visit will be collected in 3 tubes and the value will be 3 ml in each tube. i. Fasting Plasma Glucose: pre-diabetic is more than 100 mg/dl to 125 mg/dl (Alberti, Zimmet, \& Shaw, 2006). ii. Hemoglobin A1C (HgA1C): pre-diabetic HbA1c is between 5.7 - 6.5% (Alberti, Zimmet, \& Shaw, 2006). iii. Triglycerides: more than 150 mg/dl (Alberti, Zimmet, \& Shaw, 2006). iv. High Density Lipoprotein-Cholesterol: less than 40 mg/dl in men and less than 50 mg/dl in women (Alberti, Zimmet, \& Shaw, 2006).

  at baseline, after the end of the 12th week of the intervention, and after 4 weeks post-intervention follow-up (end visit).

• Metabolic Syndrome Components (Medical Assessments/ Blood Pressure)

  • Blood pressure for both groups will be measured three times sequentially at 1-min interval using the standardized method, the average between the three readings will be used as study variable (if more than 130 mmHg systolic BP/or more than 85 mmHg diastolic BP).

  at baseline, after the end of the 12th week of the intervention, and after 4 weeks post-intervention follow-up (end visit).

Study Arms (2)

Winclove's Ecologic® Barrier Probiotics

EXPERIMENTAL

Patients in the interventional group will consume psychobiotics daily in addition to their antidepressant medication for 12 weeks. All patients will be instructed to take 1 sachet in the morning before breakfast, and 1 sachet at the end of the day before going to bed. The product is a multispecies probiotic formulation consisting of 9 selected probiotic strains by Winclove's Ecologic® Barrier, Amsterdam, The Netherlands. Each participant will receive 6 boxes of the probiotic supplement, each box contains 30 sachets of 3 grams (180 sachets in total). During the period of 12 weeks, each participant will consume 168 sachets. The probiotic supplement is a freeze-dried powder of probiotic mixture at a dose of 2,5 x 109 colony forming units (CFU) per gram. Since participants should consume 2 sachets/day, they will consume 6 grams in total which equals 1.5 × 10\^10 CFU.

Dietary Supplement: Winclove's Ecologic® Barrier Probiotics

Control

PLACEBO COMPARATOR

Patients in the control group will consume similar sachets that are identical in physical appearance. The placebo is composed of the carrier of the probiotic product, that is maize starch and maltodextrins but contains no bacteria.

Dietary Supplement: Winclove's Ecologic® Barrier Probiotics Placebo

Interventions

Winclove's Ecologic® Barrier Probiotics DIETARY_SUPPLEMENT

The investigational product is a multispecies probiotic formulation consisting of 9 selected probiotic strains: the following bacterial strains: Bifidobacterium bifidum W23, Bifidobacterium lactis W52, Lactobacillus acidophilus W37, Lactobacillus brevis W63, Lactobacillus casei W56, Lactobacillus salivarius W24, Lactococcus lactis W19 and Lactococcus lactis W58.

Winclove's Ecologic® Barrier Probiotics

Winclove's Ecologic® Barrier Probiotics Placebo DIETARY_SUPPLEMENT

The placebo is composed of the carrier of the probiotic product that are identical in physical appearance, it includes maize starch and maltodextrins but contains no bacteria.

Control

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Major Depression Disorder (MDD) patients on antidepressants for at least 4 weeks or more.
• MDD patients with pre-metabolic syndrome (at least 2 of the MetS components) and metabolic syndrome (at least 3 of the following components: central obesity with WC for men ≥ 94 centimeters while for women ≥ 80 centimeter, increased FPG ≥ 100 mg/dl, increased BP to ≥ 130 / ≥ 85 mmHg, increased TGs equal or above 150 mg / dl, increased HDL cholesterol for men to \< 40 mg / dl while for women \< 50 mg / dl) (IDF., 2006).
• MDD patients with other comorbid diseases such as anxiety.

You may not qualify if:

• Patients using any other supplements to improve mood.
• Patients using pre/pro/symbiotics supplement or antibiotics during the last 3 weeks before the intervention.
• Patients with chronic diseases (cardiac, renal, or hepatic diseases)
• Patients with gastro intestinal diseases (Crohn's disease, ulcerative colitis).
• Patients with infectious diseases (HIV/AIDS).
• Cancer patients or those undergoing chemotherapy.
• Patients with food allergies such as gluten intolerance or lactose intolerance.
• Pregnant and breastfeeding women.
• Patients with modified antidepressant dose during interventional period or receiving psychotherapy during the intervention.
• Patients with thyroid disorder.
• Patients following a diet to lose weight during the intervention.
• Diabetic patients who are insulin-dependent.
• patients receiving injections or medications to lose weight (Ozempic, Mounjaro …etc) either 3 weeks before or during the intervention.
• Patients using plasma-lipid lowering drug for less than 1 month before the intervention.
• Patients with substance abuse including alcohol addiction.

Sponsors & Collaborators

• Roaa Ahmed Alkreadees: lead

Study Sites (1)

King Saud University Medical City

Riyadh, Riyadh Region, Saudi Arabia

RECRUITING

Related Publications (10)

• Altwaijri YA, Al-Habeeb A, Al-Subaie AS, Bilal L, Al-Desouki M, Shahab MK, Hyder S, Sampson NA, King AJ, Kessler RC. Twelve-month prevalence and severity of mental disorders in the Saudi National Mental Health Survey. Int J Methods Psychiatr Res. 2020 Sep;29(3):e1831. doi: 10.1002/mpr.1831. Epub 2020 Aug 15.

  PMID: 33245602 BACKGROUND

• Al-Khatib Y, Akhtar MA, Kanawati MA, Mucheke R, Mahfouz M, Al-Nufoury M. Depression and Metabolic Syndrome: A Narrative Review. Cureus. 2022 Feb 12;14(2):e22153. doi: 10.7759/cureus.22153. eCollection 2022 Feb.

  PMID: 35308733 BACKGROUND

• AlHadi AN, Alarabi MA, AlMansoor KM. Mental health and its association with coping strategies and intolerance of uncertainty during the COVID-19 pandemic among the general population in Saudi Arabia: cross-sectional study. BMC Psychiatry. 2021 Jul 28;21(1):382. doi: 10.1186/s12888-021-03370-4.

  PMID: 34320930 BACKGROUND

• Gawlik-Kotelnicka O, Strzelecki D. Probiotics as a Treatment for "Metabolic Depression"? A Rationale for Future Studies. Pharmaceuticals (Basel). 2021 Apr 20;14(4):384. doi: 10.3390/ph14040384.

  PMID: 33924064 BACKGROUND

• Gold SM, Kohler-Forsberg O, Moss-Morris R, Mehnert A, Miranda JJ, Bullinger M, Steptoe A, Whooley MA, Otte C. Comorbid depression in medical diseases. Nat Rev Dis Primers. 2020 Aug 20;6(1):69. doi: 10.1038/s41572-020-0200-2.

  PMID: 32820163 BACKGROUND

• Alberti KG, Zimmet P, Shaw J. Metabolic syndrome--a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med. 2006 May;23(5):469-80. doi: 10.1111/j.1464-5491.2006.01858.x.

  PMID: 16681555 BACKGROUND

• Liu Q, He H, Yang J, Feng X, Zhao F, Lyu J. Changes in the global burden of depression from 1990 to 2017: Findings from the Global Burden of Disease study. J Psychiatr Res. 2020 Jul;126:134-140. doi: 10.1016/j.jpsychires.2019.08.002. Epub 2019 Aug 10.

  PMID: 31439359 BACKGROUND

• Park C, Brietzke E, Rosenblat JD, Musial N, Zuckerman H, Ragguett RM, Pan Z, Rong C, Fus D, McIntyre RS. Probiotics for the treatment of depressive symptoms: An anti-inflammatory mechanism? Brain Behav Immun. 2018 Oct;73:115-124. doi: 10.1016/j.bbi.2018.07.006. Epub 2018 Jul 18.

  PMID: 30009996 BACKGROUND

• Sharma R, Gupta D, Mehrotra R, Mago P. Psychobiotics: The Next-Generation Probiotics for the Brain. Curr Microbiol. 2021 Feb;78(2):449-463. doi: 10.1007/s00284-020-02289-5. Epub 2021 Jan 4.

  PMID: 33394083 BACKGROUND

• Vlainic JV, Suran J, Vlainic T, Vukorep AL. Probiotics as an Adjuvant Therapy in Major Depressive Disorder. Curr Neuropharmacol. 2016;14(8):952-958. doi: 10.2174/1570159x14666160526120928.

  PMID: 27226112 BACKGROUND

Related Links

• Major Depressive Disorder
• UN health agency reports depression now 'leading cause of disability worldwide'
• Depression and Other Common Mental Disorders: Global Health Estimates
• Apolipoprotein B/apolipoprotein A1 ratio is a good predictive marker of metabolic syndrome and pre-metabolic syndrome in Chinese adolescent women with polycystic ovary syndrome

Central Study Contacts

Roaa A Alkreadees

CONTACT

00966555527073; 442203635@student.ksu.edu.sa

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Masking Details: The probiotic and the placebo are packed in plain white sachets, with the study acronym and shelf life printed on them. The sachets are packed in plain white boxes that are all equally labelled with the study title, instructions for use and investigator contact details. Each participant will receive 6 boxes of the same randomization number. The study team will be blinded to the contents of each box. The coordinating investigator of the study team will distribute the numbered boxes to the participants. The investigators have access to the randomization data in case it is necessary to unblind for a serious event. Sealed code break envelopes per participant (located at the investigational site in a restricted-access, fireproof, vault, accessible within 24 hours) will be used and in the event of a code break, the name of the code breaker, the signature, date and time will be recorded on the outside of the envelope. Unblinding will automatically lead to exclusion from the trial.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Study coordinator and Co-author

Study Record Dates

• First Submitted: December 24, 2024
• First Posted: January 9, 2025
• Study Start: March 2, 2025
• Primary Completion: February 28, 2026
• Study Completion (Estimated): January 30, 2027
• Last Updated: September 22, 2025

Record last verified: 2025-09

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, CSR
• Time Frame: Until January 15th, 2027.
• Access Criteria: Through electronic files.

Locations

SA (1)