April 2009

Medication Treatment for BPD: The Limited Evidence Base
Antipsychotics, especially olanzapine (Zyprexa), may be beneficial in treating borderline personality disorder, but the data are limited and mixed.

Chelation Therapy for Autism?
A study of chelation therapy for autism was stopped due to potential adverse effects.

Varenicline for Smoking Cessation
Varenicline (Chantix) should be used with caution in psychiatric patients attempting to quit smoking.

In Brief
Modifying risk factors can help prevent dementia; Increased lighting improves cognition in elderly

Minocycline for Schizophrenia: Preliminary Results
The results from an open-label study of minocycline (Solodyn and others) suggest benefit in the treatment of schizophrenia.

Minocycline for Schizophrenia: Preliminary Results

April 2009

One of the most brain-penetrable of the tetracyclines, minocycline (Solodyn and others) has anti-inflammatory and neuroprotective effects that appear unrelated to its antimicrobial action. In mouse models of Huntington's disease and amyotrophic lateral sclerosis, minocycline delays mortality or disease progression.1 Psychiatric symptoms have improved in patients with neurological diseases who took minocycline, and psychiatric patients have shown improvement in depression, schizophrenia, and catatonic symptoms. Miyaoka and others in Japan report on an open-label study of minocycline in patients with schizophrenia.1

The 22 subjects ranged in age from 20 to 58 years and had been ill for 1 to 15 years. Each was taking a second-generation antipsychotic—olanzapine (Zyprexa), risperidone (Risperdal and others), quetiapine (Seroquel), or peraspirone*—which was continued at a stable dose throughout the 4-week trial. Minocycline was added to the antipsychotic drug and titrated during the first week to a target dose of 150 mg tid for weeks 2 through 4.

All patients tolerated minocycline without adverse effect. Mean scores on the Positive and Negative Syndrome Scale (PANSS) positive, negative, and general psychopathology subscales were reduced to 40.4%, 44.0% and 52.1%, respectively, after 4 weeks of treatment, and reductions were maintained at a 4-week follow-up.

This was an open-label study, which can merely frame a hypothesis but not test it definitively. Nonetheless, this research with minocycline for a psychotic disorder is an interesting, novel, and creative approach that merits further work.

1Miyaoka T, Yasukawa R, Yasuda H, Hayashida M, Inagaki T, Horiguchi J: Minocycline as adjunctive therapy for schizophrenia: An open-label study. Clin Neuropharmacol 2008;31:287-292.