Mood and Anxiety Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, USA; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, USA.
Fairleigh Dickinson University, USA.
J Affect Disord. 2018 Apr 1;230:56-64. doi: 10.1016/j.jad.2017.12.067. Epub 2018 Jan 2.
The antibiotic minocycline appears to promote neuroprotection through antioxidant and other mechanisms that may be relevant to the pathophysiology of bipolar disorder. The present study assessed the efficacy of minocycline in bipolar depression and examined the association between minocycline treatment and brain glutathione (GSH), an essential regulator of oxidative stress.
Twenty patients with bipolar disorder experiencing acute depressive symptoms enrolled in an 8-week, open-label trial of adjuvant minocycline. Depression was assessed using the Montgomery-Asberg Depression Rating Scale (MADRS) and proton magnetic resonance spectroscopy (H MRS) measures of cortical GSH within a voxel prescribed in the precuneus and aspects of the occipital cortex were obtained from a subset of patients (n=12) before and after treatment.
The daily dose of minocycline at study end was 256mg (SD: 71mg). Treatment was associated with improvements in depression severity [MADRS score change: -14.6 (95% CI: -7.8 to -21.3)]. Ten patients (50%) were classified as responders based on a ≥50% reduction in MADRS score and 8 patients (40%) were classified as remitters (MADRS score ≤ 9). Higher baseline GSH levels were associated with greater improvement in MADRS score following treatment (ρ=0.51, p=0.05). Increases in GSH levels at study end were higher in non-responders than in responders (p=0.04).
Small sample size, lack of a placebo group.
Minocycline may be an effective adjuvant treatment for bipolar depression, particularly in patients with high baseline GSH levels. Further research is needed to evaluate the potential of minocycline in this population.
抗生素米诺环素通过抗氧化和其他可能与双相情感障碍病理生理学相关的机制似乎促进神经保护。本研究评估了米诺环素在双相抑郁中的疗效，并研究了米诺环素治疗与大脑谷胱甘肽（GSH）之间的关联，GSH 是氧化应激的重要调节剂。
20 名患有双相情感障碍且出现急性抑郁症状的患者参加了为期 8 周的米诺环素辅助治疗开放性试验。使用蒙哥马利-阿斯伯格抑郁评定量表（MADRS）和质子磁共振波谱（H MRS）评估抑郁，MADRS 评分变化：-14.6（95%CI：-7.8 至-21.3）。在治疗前后，从亚组患者（n=12）中获得了额顶叶扣带回内规定体素的皮质 GSH 的 H MRS 测量值和枕叶皮层的某些方面。
研究结束时米诺环素的日剂量为 256mg（SD：71mg）。治疗与抑郁严重程度的改善相关[MADRS 评分变化：-14.6（95%CI：-7.8 至-21.3）]。根据 MADRS 评分降低≥50%，10 名患者（50%）被分类为应答者，8 名患者（40%）被分类为缓解者（MADRS 评分≤9）。更高的基线 GSH 水平与治疗后 MADRS 评分的改善更相关（ρ=0.51，p=0.05）。在无应答者中，与应答者相比，研究结束时 GSH 水平的升高更高（p=0.04）。
样本量小，缺乏安慰剂组。
米诺环素可能是双相抑郁的有效辅助治疗方法，尤其是在基线 GSH 水平较高的患者中。需要进一步研究评估米诺环素在该人群中的潜力。
