Do Proton Pump Inhibitors (PPI) cause mental illness?

From the Guidelines

Proton pump inhibitors (PPIs) have not been proven to cause mental illness, and the current evidence does not support a causal association between PPI use and mental health conditions. The guidelines from the British Society of Gastroenterology 1 emphasize that anxiety and depression in patients with eosinophilic oesophagitis are more likely due to persistent symptoms, social restrictions, and significant dietary restrictions, rather than PPI therapy itself. While the literature on PPI side effects is extensive, it often describes associations without proof of causal association 1.

Key Points to Consider

• The British Society of Gastroenterology guidelines 1 recommend switching away from PPI therapy only if the side effects are clearly caused by the PPI, with a strong level of recommendation and 94% agreement.
• The guidelines also highlight the importance of effective therapy in alleviating anxiety and depression in patients with eosinophilic oesophagitis 1.
• The evidence suggests that mental health support needs are higher in children with eosinophilic oesophagitis, with contributing factors including significant dietary restrictions, repeat endoscopies, and percutaneous endoscopic gastrostomy (PEG) feeding 1.

Clinical Implications

• Patients taking PPIs should continue their medication as prescribed and discuss any concerns about mental health effects with their healthcare provider.
• Healthcare providers should monitor patients for potential side effects of PPI therapy, such as diarrhea, gastrointestinal infections, or magnesium deficiency, and consider alternative treatments if necessary 1.
• The potential benefits of PPI therapy in managing conditions like GERD, peptic ulcers, and H. pylori infections should be weighed against the potential risks and side effects, with individualized decision-making and regular monitoring 1.

From the Research

Proton Pump Inhibitors (PPI) and Mental Illness

• The relationship between Proton Pump Inhibitors (PPI) and mental illness is a topic of interest, with some studies suggesting a potential link between long-term PPI use and increased risk of dementia 2, 3.
• A review of the evidence suggests that PPIs have been associated with an increased risk of adverse effects, including dementia, in older adults 2.
• Another study found that long-term PPI use may be associated with an increased risk of dementia, although the causal association is still subject to validation 3.
• It is essential to note that the current evidence is primarily based on observational studies, and more research is needed to fully understand the relationship between PPI use and mental illness.

Adverse Effects of PPI Use

• PPIs have been linked to various adverse effects, including gastrointestinal infections, pneumonia, nutrient deficiencies, fractures, and small intestinal bacterial overgrowth 4, 5.
• Long-term PPI use has also been associated with an increased risk of kidney disease, myocardial infarction, and stroke 3, 6.
• The risk of adverse effects should not be a reason to withhold PPIs from patients with a true indication, but rather to critically evaluate the indication and reconsider the need for long-term treatment 5.

Safe Use of PPIs

• The key to mitigating adverse effects is the rational use of PPIs at the lowest effective dose and in the shortest possible duration 3.
• Provider awareness and patient education are crucial in ensuring the safe and effective use of PPIs 4.
• Regular evaluation of the need for continued PPI use is recommended, particularly in older adults, to minimize the risk of adverse effects 2.