Association between antidepressants and antimicrobial resistance: a scoping review.

BackgroundAntimicrobial resistance and depression are leading causes of global morbidity and mortality. Depression is the most common mental health disorder, with antidepressant use doubling between 2000 and 2022. Infectious diseases are increasingly difficult to treat due to some antimicrobial agents becoming ineffective. Antibiotic use is known to drive resistance in clinical bacterial infections, and laboratory studies have found that antidepressants have antibiotic properties, affecting the microbiota and stimulating mechanisms that help certain bacteria resist antibiotics. AimTo map and evaluate existing literature on the association between antidepressants and antimicrobial resistance. MethodsThis scoping review followed the modified Arksey and OMalleys framework. Systematic searches of MEDLINE, PubMed, Scopus and grey literature were conducted. Studies were screened for eligibility, assessed for risk of bias using ToxRTool, and analysed using a narrative synthesis. ResultsTen articles met the inclusion criteria, eight laboratory studies and two reviews. Studies reported that exposure of bacteria to antidepressants increased antibiotic resistance. There were no eligible human or animal microbiome, or population studies. ConclusionThis scoping review highlights the need for microbiome, clinical, and population studies. Associations between antidepressants and antibiotic resistance in clinical infections have implications for real-world practice, impacting clinical guidelines and patient care. Key MessagesO_ST_ABSWhat is already known on this topicC_ST_ABSDepression and antibiotic resistance are both critical global health concerns. The use of antidepressant drugs is increasing and there is a growing body of laboratory evidence demonstrating that antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), exhibit antimicrobial activity against bacteria. What this study addsThis scoping review maps and synthesizes existing evidence on associations between antidepressants and antimicrobial resistance, including mechanisms involved, and identifies important gaps in the literature. The eight primary research studies included were all laboratory-based, bacterial studies. All found that exposure of bacteria to antidepressant drugs increased antibiotic resistance. There were no eligible human or animal microbiome studies, or human clinical or population studies. How this study might affect research, practice or policyThis scoping review highlights the need for more microbiome, clinical, and population studies. Associations between antidepressants and antibiotic resistance in clinical infections could have implications for real-world practice, impacting clinical guidelines and patient care.