Clostridium difficile infection is linked to 14,000 deaths each year in the United States and continues to increase each year.1 Antibiotic use is the major cause of C. diff infection, but other medications are known to increase risk, including proton-pump inhibitors and h-2 blockers, which are both stomach acid-blocking medications. Another class of drugs that is coming to light as a risk factor for C. diff is antidepressants. Interestingly, it turns out that it’s not just antidepressants, but depression itself that increases risk.

A recent study published in the journal BMC Medicine found that the risk of C. difficile infection was even greater in patients diagnosed with major depression or on antidepressants than it was for people taking PPIs or H-2 blockers.2 Depression is the third most prevalent disabling condition worldwide, according to the World Health Organization. Not only do antidepressants and depression increase risk of C. diff, but people who simply reported feeling sad or having emotional, nervous, or psychiatric problems were also at increased risk. Widowed individuals and those living alone were also at increased risk. This tells us that there are many people who are at risk.

It is known that depression alters the gut microbiota and increases intestinal permeability (leaky gut). Likewise, leaky gut and altered gut microbiota increase depression symptoms.3 The truth is, the connection between the gut and brain goes both ways, which can create a vicious cycle. “In a 12-year prospective study, the relationship between anxiety, depression, and functional GI (gastrointestinal) disorders appeared to be bi-directional, in that psychiatric disorders predicted GI disease and vice versa,”4 stated the researchers. “It is possible that there is a lifelong liaison between the gut microbiota and neurologic response to external stimuli.”

Even stress alone has been found to cause a decrease in the beneficial gut bacteria.5 And we know that stress can lead to depression and anxiety, along with a host of other health conditions. To break this vicious cycle, eat a diet that supports a healthy gut balance—with plenty of high-fiber foods in the form of non-starchy vegetables and fruits, healthy fats, lean proteins, nuts, and seeds—along with taking probiotic and omega-3 supplementation, vitamin D, and digestive enzymes for proper digestion of food.

It would be wise to test for omega-3 and vitamin D levels at least once or twice a year. If you are dealing with inflammation requiring higher doses, you may need more frequent testing and monitoring through your healthcare practitioner since you will want to keep your omega-3 and vitamin D levels optimal.

In addition, it is important that you manage stress with an activity that relaxes you—mentally and physiologically. One of the best ways to achieve this is through a breathing meditation. If the idea of meditation sounds intimidating, I encourage you to check out Heart Math Institute. They have developed wonderful tools that guide you through breathing exercises and visualizations. Their techniques have been found to reduce a variety of negative health effects related to stress, including high blood pressure, anxiety, anger, and more.

By addressing gut health along with mental health—they go hand in hand—we can more effectively manage such detrimental, and somewhat preventable, conditions such as C. difficile infection. Prevention is key, which is why I recommend a healthy eating and living habits to everyone.



  1. Centers for Disease Control and Prevention (CDC). QuickStats: rates of Clostridium difficile infection among hospitalized patients aged ≥65 years, by age group — National Hospital Discharge Survey, United States, 1996-2009. MMWR Morb Mortal Wkly Rep. 2011;60(34):1171.
  2. Roger MA, Greene MT, Young VB, et al., “Depression, antidepressant medications, and risk of Clostridium difficile infection.” BMC Medicine. 2013;11:121.
  3. Koloski NA, Jones M, Kalantar J, et al., “The brain–gut pathway in functional gastrointestinal disorders is bidirectional: a 12-year prospective population-based study.” Gut. 2012 Sep;61(9):1284-90.
  4. Maes M, Kubera M, Leunis JC, “The gut-brain barrier in major depression: intestinal mucosal dysfunction with an increased translocation of LPS from gram negative enterobacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression.” Neuro Endocrinol Lett. 2008 Feb;29(1):117-24.
  5. Baily MT and Coe CL, “Maternal separation disrupts the integrity of the intestinal microflora in infant rhesus monkeys.” Dev Psychobiol. 1999 Sep;35(2):146-55.