Efficacy and tolerability of minocycline in depressive patients with or without treatment-resistant: a meta-analysis of randomized controlled trials

Youjia Qiu; Aojie Duan; Ziqian Yin; Minjia Xie; Zhouqing Chen; Xiaoou Sun; Zhong Wang; Xuwei Zhang

doi:10.3389/fpsyt.2023.1139273

Efficacy and tolerability of minocycline in depressive patients with or without treatment-resistant: a meta-analysis of randomized controlled trials

Front Psychiatry. 2023 Jun 5:14:1139273. doi: 10.3389/fpsyt.2023.1139273. eCollection 2023.

Authors

Youjia Qiu^#^{1

2}, Aojie Duan^#², Ziqian Yin³, Minjia Xie², Zhouqing Chen², Xiaoou Sun², Zhong Wang^{1

2}, Xuwei Zhang¹

Affiliations

¹ Department of Neurosurgery, Lianyungang Hospital of Traditional Chinese Medicine, Lianyungang, Jiangsu, China.
² Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
³ Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China.

^# Contributed equally.

Abstract

Background: Minocycline, an antibiotic with anti-inflammatory, antioxidant, and neuroprotective properties, has been used for treating psychiatric disorders in research. This systematic review aimed to evaluate the efficacy and tolerability of minocycline in patients having depression with or without treatment-resistance.

Methods: Electronic databases including Embase, PubMed, and the Cochrane library were searched for relevant studies published up to October 17, 2022. The primary efficacy outcome was the change in depression severity scores and the secondary efficacy outcomes included the changes in Clinical Global Impression (CGI) and Beck Depression Inventory (BDI) scores and the incidence of response and partial response. Safety outcomes were evaluated based on the incidence of classified adverse events and all-cause discontinuation.

Results: Five studies with 374 patients were selected for analysis. The minocycline group demonstrated a significant reduction in depression severity scale (standardized mean difference [SMD]: -0.59, 95% confidence interval [CI]: -0.98 to -0.20, P = 0.003) and CGI (SMD: -0.28, 95% CI: -0.56 to -0.01, P = 0.042) scores; however, no statistical difference was found in terms of the BDI score, response, and partial response. No significant differences were found between the groups in terms of adverse events (other than dizziness) and discontinuation rates. Subgroup analysis showed that minocycline was also effective in reducing depression severity scores in treatment-resistant depression (SMD: -0.36, 95% CI: -0.64 to -0.09, P = 0.010). Subgroup analysis of Hamilton Depression Rating Scale (17-item) scores showed a statistical difference in response in patients with depression (relative risk: 2.51, 95% CI: 1.13 to 5.57, P = 0.024).

Conclusions: Minocycline may improve depressive symptoms and augment response to treatment in patients with depression irrespective of treatment-resistance. However, clinical trials with large sample sizes are warranted for evaluating long-term outcomes with minocycline.

Systematic review registration: https://inplasy.com/inplasy-2022-12-0051/.

Keywords: depression; major depressive disorder (MDD); meta-analysis; minocycline; treatment-resistant depression (TRD).

Publication types

Systematic Review