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Minocycline

Therapeutic Potential in Psychiatry

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Abstract

Pharmacological interventions to treat psychiatric illness have previously focused on modifying dysfunctional neurotransmitter systems to improve symptoms. However, imperfect understanding of the aetiology of these heterogeneous syndromes has been associated with poor treatment outcomes for many individuals. Growing evidence suggests that oxidative stress, inflammation, changes in glutamatergic pathways and neurotrophins play important roles in many psychiatric illnesses including mood disorders, schizophrenia and addiction. These novel insights into pathophysiology allow new treatment targets to be explored. Minocycline is an antibiotic that can modulate glutamate-induced excitotoxicity, and has antioxidant, anti-inflammatory and neuroprotective effects. Given that these mechanisms overlap with the newly understood pathophysiological pathways, minocycline has potential as an adjunctive treatment in psychiatry. To date there have been promising clinical indications that minocycline may be a useful treatment in psychiatry, albeit from small trials most of which were not placebo controlled. Case reports of individuals with schizophrenia, psychotic symptoms and bipolar depression have shown serendipitous benefits of minocycline treatment on psychiatric symptoms. Minocycline has been trialled in open-label or small randomized controlled trials in psychiatry. Results vary, with findings supporting use in schizophrenia, but showing less benefit for nicotine dependence and obsessive-compulsive disorder. Given the limited data from rigorous clinical trials, further research is required. However, taken together, the current evidence suggests minocycline may be a promising novel therapy in psychiatry

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Acknowledgements

No sources of funding were used to prepare this review. MB has received grant/research support from the NIH, Simons Autism Foundation, Cancer Council of Victoria, Stanley Medical Research Foundation, MBF, NHMRC, Beyond Blue, Geelong Medical Research Foundation, Bristol Myers Squibb, Eli Lilly, GlaxoSmithKline, Organon, Novartis, Mayne Pharma and Servier; has been a speaker for Astra Zeneca, Bristol Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen Cilag, Lundbeck, Merck, Pfizer, Sanofi Synthelabo, Servier, Solvay and Wyeth; and served as a consultant to Astra Zeneca, Bristol Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen Cilag, Lundbeck and Servier. FG has received grant/research support from the ASBD, AstraZeneca, Pfizer and the RANZCP. OD has received grant/research support from Simons Autism Foundation, Stanley Medical Research Institute, NHMRC and an ASBD/Servier grant. JF has no potential conflicts of interest.

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  1. Deakin University, School of Medicine, Barwon Health, Geelong, VIC, Australia

    Olivia M. Dean & Michael Berk

  2. Mental Health Research Institute, Parkville, VIC, Australia

    Olivia M. Dean, João Data-Franco & Michael Berk

  3. Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia

    Olivia M. Dean, Francesco Giorlando & Michael Berk

  4. Psychiatric Department, Hospital Santa Maria, Lisbon, Portugal

    João Data-Franco

  5. Orygen Youth Health Research Centre, Parkville, VIC, Australia

    Michael Berk

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Dean, O.M., Data-Franco, J., Giorlando, F. et al. Minocycline. CNS Drugs 26, 391–401 (2012). https://doi.org/10.2165/11632000-000000000-00000

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