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Could poop be the answer to bipolar depression?

A novel study, Women's College Hospital researcher evaluates whether fecal microbiota transplantation will improve depressive symptoms for individuals with bipolar disorder

May 14, 2018  |  Download Release

The human body is home to complex microbial communities, also known as the human ‘microbiome’, that cover our skin and mucosal surfaces, like our internal organs. Increasingly, scientific evidence suggests a connection between the microbes that live in our intestine, our gut, and our central nervous system (CNS). Although the pathways linking intestinal bacteria with the brain are not completely understood, there is reason to believe that manipulating the gut microbiome has an impact on brain activity and affects behaviors associated with anxiety and depression.

A unique study authorized by Health Canada and by the Women’s College Research Institute (WCRI) Research Ethics Board, led by Dr. Valerie Taylor, Psychiatrist-in-Chief, Women’s College Hospital (WCH) and scientist, WCRI, aims to further explore how fecal microbiome transplantation (FMT), a technique in which gut microbiota are transferred from a healthy donor to a patient to introduce, or restore, a stable community of microbes in the intestines, affects people living with bipolar depression. Previous animal studies have suggested that gut microbes are linked to brain health, but this theory has not yet been fully explored in humans.

In this new study, patients with bipolar depression will be randomized into two different groups – one group will receive FMT from a healthy, screened donor, and the second group will receive FMT re-infusion of their own feces. The research team theorizes that the introduction of new healthy gut microbes will directly impact the microbiome-gut-brain pathway, reducing depressive symptoms. The exact mechanism causing the reduction in depressive symptoms is not known yet, but may be the result of an anti-inflammatory response following the introduction of new gut microbes along with alteration of the patient’s present microbes.

“Bipolar disorder is a mental illness that impacts five per cent of Canadians. Patients with bipolar disorder struggle with extreme mood swings that can impact both their physical health and social lives,” notes Dr. Taylor, principal investigator. “Fecal microbiota transplantation may represent an innovative new treatment option in combination with standard medications, and we are excited to explore this possibility.”

While the strongest support for the clinical application of FMT is from the gastrointestinal field, evidence is mounting to support the use of FMT in other clinical areas.  FMT is now a standard treatment for patients with Clostridium difficile (C. difficile), while other proposed studies are investigating its impact on gastrointestinal disorders including obesity, Irritable Bowel Syndrome and Crohn’s Disease. The study team recently created a novel Microbiota Therapeutics Outcomes Program (MTOP) at the University of Toronto to explore potential therapeutic applications for FMT for a number of clinical conditions. This will be the first study worldwide of FMT related to mental health.

The fecal microbiota will be prepared in a microbiology lab at Mount Sinai Hospital then the study participant will undergo the FMT procedure at Toronto General Hospital, representing a significant multi-hospital collaboration.  After the participants complete the FMT procedure, their depression symptoms will be evaluated through a series of follow up assessments at WCH to determine the effectiveness of this procedure. The study will run for approximately two years, with the results anticipated to be published in early 2020. Dr. Taylor and her team are currently recruiting both participants with bipolar depression and healthy individuals to donate their stool. More information about the study can be found on the study website.

About Bipolar Disorder

Bipolar disorder is a mental health condition that causes extreme mood swings that include emotion highs (mania) and lows (depression) of varying frequencies. This condition is the result of an imbalance of the neurotransmitters in the brain. Individuals with bipolar disorder usually experience periods of wellness between episodes of depression or mania. According to Statistics Canada, one per cent of Canadians aged 15 years and over reported symptoms that met the criteria for bipolar disorder in the previous 12 months. Nearly 90 per cent of these individuals reported that the condition interfered with their lives, with the risk of suicide much higher among those with bipolar disorder compared to the general population.



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