Minocycline for Bipolar Depression?

Preliminary findings indicate that this common antibiotic with anti-inflammatory effects may improve depression levels.

Recent research has demonstrated the etiologic relationship between depression and inflammation (NEJM JW Psychiatry May 2010 and Biol Psychiatry 2010; 67:446) and anti-inflammatory medications as potential treatment (NEJM JW Psychiatry Feb 2013 and JAMA Psychiatry 2013; 70:31).

In an open-label, 8-week study, researchers explored the use of adjunctive minocycline, an antibiotic with known effects on inflammatory cytokines, for treating 29 outpatients with bipolar (type I or II) disorder and major depression.

Twice-daily, 100-mg minocycline was added to patients' current medication regimen, which included anticonvulsants (67%), atypical antipsychotics (56%), and lithium (26%). Analyses were performed on 27 patients (mean duration of current depression, 22 weeks; total duration of illness, 25 years).

Adjunctive minocycline was associated with significant reductions in depressive symptoms. On the depression scale used as the main outcome measure, the response rate was 26%, and the remission rate was 11%. In post hoc analyses, only patients with histories of early life adversity demonstrated a response. Responders had improved psychomotor speed but no changes on other measures of cognition. Decreasing levels of one cytokine (CCL26) were associated with poorer response. Seven patients were discontinued from the trial because of adverse events, two of which were serious — a mixed manic episode and an occurrence of severe abdominal pain.

Comment

These results add to the literature suggesting a connection between inflammation and depression. The usual caveat regarding an open study pertains; this medication needs to be examined in a controlled study. This study did not include treatment-refractory patients — only nonresponders. Whether a clinical history of early life adversity is an important prognostic factor needs to be prospectively studied. Minocycline, a common antibiotic, could become another adjunctive medication for a difficult-to-treat condition.

Reviewing Author

Jonathan Silver, MD

Disclosures

RoyaltiesTextbook of Traumatic Brain Injury, 2nd and 3rd editions

Editorial BoardsUpToDate; Journal of Neuropsychiatry and Clinical Neuroscience

Leadership Positions in Professional SocietiesNorth American Brain Injury Association (Board Member); National Institute on Disability, Independent Living, and Rehabilitation Research (Chair of Data Monitoring Safety Board for study of donepezil on cognition after traumatic brain injury)