In Reply We appreciate the observations and comments raised in the letters from Regenold as well as from Silverman and Bondy regarding our study on the association between hospitalizations with infection and risk of death by suicide.1
Regenold suggests that the treatment of infections with antibiotics can potentially cause mitochondrial dysfunction in the brain, which might increase the risk of developing mental disorders, including depression and bipolar disorder, possibly contributing to the observed increased risk of suicide after infections. This adds to our discussion of whether infections and treatment with antibiotics might affect the gut microbiome, as studies indicate that alterations of the gastrointestinal microbiota may affect brain function and lead to alterations in behavior in animal models.2,3 Previous large-scale studies have mainly focused on severe infections that required hospitalizations. We agree that it is highly relevant and important to study the associations with specific antibiotic treatment of infections and the risk for mental disorders and suicide. This could be addressed using the nationwide data that are available in the Nordic countries.
Lund-Sørensen H, Benros ME, Erlangsen A. Association Between Hospitalization for Infection and Suicide—Reply. JAMA Psychiatry. 2017;74(2):199. doi:10.1001/jamapsychiatry.2016.3468
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