New Hope for Social Anxiety Disorder, Part 1
Social anxiety disorder has a connection to the gut microbiota.
“L’enfer, c’est les autres [Hell is other people].” ―Jean-Paul Sartre
The surprising connection between gut microbes and mood is called the gut-brain axis. It plays a role in depression and anxiety and has recently captured the attention of psychiatrists, who are anxious themselves about the mixed results of many psychoactive drugs.
Since the first mouse experiments a decade ago, the gut-brain axis has been found to be involved with anxiety, depression, autism, dementia, and schizophrenia. A recent study from John Cryan, Ted Dinan, Mary Butler, and colleagues from University College Cork (UCC) adds social anxiety disorder to that list as well.
Social anxiety disorder is a chronic mental health condition that causes sufferers to be anxious in social situations where they may be exposed to scrutiny and perceived judgement. Everyday social interactions can lead to embarrassment, fear, and excessive self-consciousness.
For someone with social anxiety, it can be exhausting to make it through the day. As Albert Camus noted, “Some people expend tremendous energy merely to be normal.” It affects some 13 percent of Americans, with similar rates in Europe.
If you have social anxiety disorder, you are in good company. Famous sufferers include Franz Kafka, Emily Dickinson, Adele, Jennifer Lopez, and Johnny Depp. This surprising list demonstrates that social anxiety is fully compatible with talent, and even the ability (with a struggle) to take the stage.
Some sufferers self-medicate with drugs or alcohol. Ernest Hemingway, known for his struggles with mood disorders, said, “An intelligent man is sometimes forced to be drunk to spend time with his fools.” However, these cures only exacerbate the problem, and in Hemingway’s case did not prevent his suicide.
It Starts Early
Social anxiety is often a life-long disorder, and for most sufferers, it comes with other unhelpful baggage, including irritable bowel syndrome, depression, and a greater risk of suicide. Talk therapy and antidepressants have had modest success in dealing with this disorder, but sadly, fewer than half of patients respond to treatment. Worse yet, only a fifth of patients achieve remission after three months of treatment.
Clearly, medicine is failing many of those with social anxiety. But if microbes play a role, that’s good news: We can manipulate our gut microbes with dietary changes, and that could be a valuable lever to lift the anxiety.
The Study
The UCC study looked at 31 people with social anxiety and 18 age-matched controls. They discovered two species of bacteria that correlated to anxiety, one positively and one negatively.
Levels of the bacteria Anaeromassilibacillus An250 were higher in the anxiety group. This tracks with a 2022 Harvard study finding that negative emotions were also associated with higher levels of Anaeromassilibacillus An250.
This bacteria, with its tongue-twisting name, represents a new genus, first discovered in a one-year-old Senegalese child with kwashiorkor. It is a member of a family of bacteria that is also associated with autism, depression, and schizophrenia.
In a separate study, Anaeromassilibacillus was found to have higher abundance in untreated depression than in patients on antidepressants, suggesting that the meds may kill it off and improve sociability. Conversely, it’s also possible that a positive response to treatment lowers the abundance. It will take more studies to tease out the direction of causality.
Fortunately, the levels of Anaeromassilibacillus can be reduced with prebiotics, and this has been shown to reduce behavioral irritability in children with autism spectrum disorder.
That’s the villain of our microbial story. On the heroic side, the study noted that levels of the beneficial bacteria Parasutterella excrementihominis were higher in the control group than in the anxiety group. Microbes that are associated with better mood have been termed psychobiotics. The study found other psychobiotic microbes as well, all diminished in patients with social anxiety disorder.
The study adds to the growing body of evidence linking gut microbiota to social brain function. John Steinbeck, another famous anxiety sufferer, said, “A sad soul can kill quicker than a germ.” In fact, today we know that germs and sadness are correlated, and it is probably a two-way street.
Just as important, the study shows that good microbes are associated with less anxiety. John Cryan says, “These preliminary data further confirm that our microbes can be friends with social benefits.”
Stay tuned for the part 2 of this article next week, where we put this knowledge to work, and provide some tips to alleviate social anxiety.