The Combination of Anxiety and Depressive Disorders in Patients with Irritable Bowel Syndrome (Literature Review and Expert Council Resolution)

Aim : to review current understanding of the role of intestinal microbiota in the pathogenesis of irritable bowel syndrome (IBS), anxiety and depressive disorders, and to present the materials of the Expert Council, which met on April 19, 2025, in Moscow. Key points. A likely unifying factor in the development of IBS, anxiety, and depressive disorders is a change in the composition of the intestinal microbiota, which causes disruption of neuroendocrine, immune, and metabolic signaling pathways of interaction between the gut and brain (components of the gut-brain axis). The intestinal microbiota plays a coordinating role in maintaining the physiological constancy of these pathways. However, when its composition is disrupted, pathogenic mechanisms are activated, leading to the combined development of both IBS and anxiety and depressive disorders. Recent data have shown that patients with IBS, as well as those suffering from anxiety and depressive disorders, exhibit a unidirectional change in the composition of the intestinal microbiota, characterized by a decrease in the number of Bifidobacterium bacteria , suggesting their key role in the pathogenesis of these diseases. A pathogenetically substantiated therapeutic strategy for the combination of IBS and mental disorders includes modifying the gut microbiota using strain-specific pro biotics containing Bifidobacterium type species. Bifidobacterium longum 35624 and Bifidobacterium longum 1714 strains have demonstrated clinical efficacy in reducing the severity of IBS symptoms, anxiety, and depression. Conclusion . Prescribing a combination of Bifidobacterium longum 35624 and Bifidobacterium longum 1714 probiotic strains to patients with IBS, including those with comorbid mental disorders, is clinically justified. This combination of strains holds promise for inclusion in clinical guidelines for the management of patients with irritable bowel syndrome and mental and behavioral disorders.