Minocycline as Adjunctive Treatment in Depression

Posted on September 22, 2017

Dysregulation of the immune system is implicated as an etiological factor in the pathogenesis of depression. Evidence suggests that individuals that develop depression in the context of inflammation may constitute a distinct subtype. [1]

The role of the immune system may also explain the association between stress, depression and heart disease.

Therefore, drugs that modulate the immune system have gained attention in the treatment of depression. Recently published meta-analyses have shown there is support for the use of compounds such as infliximab (monoclonal antibody used in autoimmune diseases), celecoxib (NSAID used in rheumatoid arthritis), aspirin (common pain relief with potential immunotherapy properties), and N-acetylcysteine (a modified amino acid that is purported to have antioxidant properties). [2], [3]

infliximab -mcab

Infliximab binding to TNF-alpha inhibiting the binding of TNF-alpha to its receptors preventing the downstream inflammatory cascade.

 

References

1. Is depression an inflammatory disorder?
Raison, C. L., & Miller, A. H. (2011). Is depression an inflammatory disorder?. Current psychiatry reports, 13(6), 467-475.
2. Effect of anti-inflammatory treatment on depression

Kohler O et al., Effect of anti-inflammatory treatment on depression, depressive symptoms, and adverse effects: A systematic review and meta-analysis of randomized clinical trials. JAMA Psychiatry. 2014.

3. N-acetylcysteine in depressive symptoms and functionality: a systematic review and meta-analysis.

Fernandes B et al., N-acetylcysteine in depressive symptoms and functionality: a systematic review and meta-analysis. Journal of clinical Psychiatry. 2016

4. Inhibitory action of minocycline on release of nitric oxide and prostaglandin E2

Kim S et al., Inhibitory action of minocycline on lipopolysaccharide-induced release of nitric oxide and prostaglandin E2 in BV2 microglial cells. Archives of Pharmacal Research. 2004.

5. Minocycline effects on cerebral edema

Homsi S et al., Minocycline effects on cerebral edema: Relations with inflammatory and oxidative stress markers following traumatic brain injury in mice. Brain Research. 2009.

6. Minocycline therapeutic potential in psychiatry

Dean O et al., Minocycline therapeutic potential in psychiatry. CNS Drugs. 2012.

7. Efficacy and tolerability of minocycline augmentation therapy in schizophrenia

Oya K et al., Efficacy and tolerability of minocycline augmentation therapy in schizophrenia: A systematic review and meta-analysis of randomized controlled trials. Human Psychopharmacology. 2014.

8. Adjunctive minocycline treatment for major depressive disorder: A proof of concept trial

Dean O et al., Adjunctive minocycline treatment for major depressive disorder: A proof of concept trial. Australia and New Zealand Journal of Psychiatry. 2017

9. Minocycline's synergy with antidepressants

Molina-Hernandez M et al., Desipramine or glutamate antagonists synergized the antidepressant-like actions of intra-nucleus accumbens infusions of minocycline in male Wistar rats. Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2008.

10. The concept of depression as a dysfunction of the immune system.
Leonard, B. E. (2010). The concept of depression as a dysfunction of the immune system. In Depression: From Psychopathology to Pharmacotherapy (Vol. 27, pp. 53-71). Karger Publishers.