GUT MICROBIOTA AND THE GUT–BRAIN AXIS IN ANXIETY DISORDERS: CURRENT EVIDENCE AND THERAPEUTIC PERSPECTIVES

Abstract

Anxiety disorders are among the most prevalent mental health conditions worldwide and constitute a significant public health challenge. Their pathogenesis is multifactorial and involves complex interactions between genetic, environmental, immunological, and neurobiological factors. In recent years, increasing attention has been directed toward the potential role of the gut microbiota and the gut–brain axis in the development and progression of anxiety disorders. The aim of this narrative review was to summarize current knowledge regarding the relationship between gut microbiota and anxiety disorders, with particular emphasis on the biological mechanisms underlying gut–brain communication and potential therapeutic implications. The review was based on scientific publications indexed in PubMed, Scopus, and Google Scholar databases, including preclinical studies, clinical trials, systematic reviews, and meta-analyses published mainly between 2010 and 2025. Available evidence indicates that gut microorganisms moderate central nervous system functioning through neural, immunological, endocrine, and metabolic pathways. Dysbiosis has been associated with altered stress responses, neuroinflammation, disturbances in neurotransmitter regulation, and hypothalamic–pituitary–adrenal axis dysfunction. Both animal and human studies suggest that alterations in gut microbiota composition may contribute to anxiety-related symptoms. Although microbiota-targeted interventions such as probiotics, prebiotics, dietary modifications, and fecal microbiota transplantation show promising results, current evidence remains insufficient for routine clinical implementation. Further well-designed clinical studies are necessary to clarify the role of gut microbiota in anxiety disorders and to evaluate the effectiveness of microbiota-based therapeutic strategies.