Minocycline not superior to placebo for depressive symptoms in people with TRD

October 07, 2022

2 minute read


Hellmann-Regen does not report any relevant financial information. Please see the study for relevant financial information from all other authors.

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According to a study published in Open JAMA Network.

“Major depressive disorder is a significant cause of disability worldwide,” Julian Hellmannot-Regen, MD, from the department of psychiatry and neuroscience at the Charite Medical University Hospital in Berlin, and colleagues wrote. “Insufficient response rates, persistent residual symptoms, frequent relapses, or recurrence of symptoms are unsatisfactory results of conventional antidepressant treatments.”

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Hellmann-Regen and colleagues sought to determine whether minocycline, which inhibits microglial activation, for people with MDD, in addition to usual antidepressant treatment, can significantly reduce depressive symptoms in patients with TRD.

Their study was conducted at nine university hospitals across Germany in a multicenter, double-blind, randomized clinical trial. The researchers included a total of 173 people aged 18 to 75, with a diagnosis of MDD, a severity of depressive symptoms on the Hamilton Depression Rating Scale (HAMD-17) greater than or equal to 16 points , a BMI of 18 to 40, Clinical Global Impression Scale (CGI-S) greater than or equal to 4, and inability to respond adequately to an initial standard antidepressant according to the Massachusetts General Hospital Antidepressant Treatment History Questionnaire which had received a prescribed stable medication for at least 2 weeks.

Participants were randomized on a 1:1 basis to receive either add-on minocycline (200 mg/d) or placebo for 6 weeks, with a 6-week follow-up. The primary outcome was a change in Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline to week 6, as analyzed by repeated measures intention-to-treat mixed model. Secondary outcomes were response, remission, and various other clinical rating scales.

According to the study, 168 participants formed the intention-to-treat sample (79 women, 89 men, 159 whites), including 81 in the minocycline group and 87 in the placebo group.

The mean MADRS score of the sample at baseline was 26.5 (5). Minocycline treatment did not alter the course of depression severity compared with placebo, as assessed by a decrease in MADRS scores over 6 weeks of treatment (1.46 [1.04 to 3.96]). Minocycline treatment also showed no statistically significant effect on secondary outcomes. There was no difference in completion rates between the minocycline group (83.3%) and the placebo group (83.1%).

“Our results … are of great clinical significance, robustly demonstrating that minocycline adjunct therapy does not outperform placebo,” Hellmann-Regen and colleagues wrote.

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