In autoimmune conditions like PANS and PANDAS that manifest with OCD and depression, antibiotics are effective in improving psychiatric symptoms.
"Actually, the PANS autoimmune with OCD and depression, PANDAS—... It's a—call it PANS clinic at Stanford, but I've seen a lot of cases there where antibiotics are really helpful for the psychiatric symptoms." (said at 1:08:44)
Antibiotics (such as azithromycin) are widely used in specialized clinics for pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Clinical trials and reviews offer preliminary support for their role in improving psychiatric symptoms (notably obsessive-compulsive symptoms), but the overall evidence base remains limited. A double-blind pilot randomized controlled trial found significant improvements on the Clinical Global Impressions severity scale (CGI-S) and higher responder rates with azithromycin compared to placebo, though differences on the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) were not statistically significant.
- supports: A Double-Blind Randomized Placebo-Controlled Pilot Study of Azithromycin in Youth with Acu… (Journal of child and adolescent psychopharmacology 2017)
"Participants in the azithromycin group (n = 17) showed significantly greater reductions in OCD severity on the CGI-S OCD than the placebo group (n = 14) posttreatment (p = 0.003), although there were no significant differences on the CY-BOCS. Significantly more participants in the azithromycin condition met treatment responder criteria on the CGI-I OCD at the end of week 4 (41.2%, n = 7) in comparison to the placebo group (7.1%, n = 1; p = 0.045)." (abstract, results, passage verified)
pubmedfull study (doi) - context: Antibiotics for PANDAS? Limited Evidence: Review and Putative Mechanisms of Action. (The primary care companion for CNS disorders 2018)
"Although the single studies conveyed no statistically significant results, there is some evidence for efficacy of antibiotic therapy in reducing neuropsychiatric symptoms in the PANDAS/PANS population. Whereas the use of eradicating antibiotic therapy during active infections in PANDAS/PANS is well established, there is still a need for studies that improve the quality of evidence supporting use of antibiotics in this population independent of ongoing infections." (abstract, results, passage verified)
pubmedfull study (doi)