Minocycline Therapeutic Potential in Psychiatry
Minocycline Therapeutic Potential in Psychiatry
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DOI：
10.2165/11632000-000000000-00000
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发表时间：
2012-01-01
期刊：
影响因子：
6
通讯作者：
Berk, Michael
中科院分区：
文献类型：
--
作者：
Dean, Olivia M.;Data-Franco, Joao;Berk, Michael
治疗精神疾病的药物干预以前集中在修改功能失调的神经递质系统以改善症状。然而，对这些异质性综合征的病因学的不完全理解与许多个体的不良治疗结果相关。越来越多的证据表明，氧化应激，炎症，代谢途径和神经营养因子的变化在许多精神疾病，包括情绪障碍，精神分裂症和成瘾中发挥重要作用。这些对病理生理学的新见解允许探索新的治疗靶点。米诺环素是一种能够调节谷氨酸诱导的兴奋性毒性的抗生素，具有抗氧化、抗炎和神经保护作用。鉴于这些机制与新理解的病理生理学途径重叠，米诺环素有可能作为精神病学的一种治疗方法。到目前为止，已经有很有希望的临床迹象表明，米诺环素可能是一个有用的治疗精神病学，虽然从小试验，其中大多数不是安慰剂对照。精神分裂症、精神病性症状和双相抑郁患者的病例报告显示，米诺环素治疗对精神病性症状有意外获益。米诺环素已经在精神病学的开放标签或小型随机对照试验中进行了试验。结果各不相同，研究结果支持在精神分裂症中使用，但对尼古丁依赖和强迫症的益处较少。鉴于严格的临床试验数据有限，需要进一步研究。然而，综合考虑，目前的证据表明米诺环素可能是一种有前途的新疗法在精神病学。
Pharmacological interventions to treat psychiatric illness have previously focused on modifying dysfunctional neurotransmitter systems to improve symptoms. However, imperfect understanding of the aetiology of these heterogeneous syndromes has been associated with poor treatment outcomes for many individuals. Growing evidence suggests that oxidative stress, inflammation, changes in glutamatergic pathways and neurotrophins play important roles in many psychiatric illnesses including mood disorders, schizophrenia and addiction. These novel insights into pathophysiology allow new treatment targets to be explored. Minocycline is an antibiotic that can modulate glutamate-induced excitotoxicity, and has antioxidant, anti-inflammatory and neuroprotective effects. Given that these mechanisms overlap with the newly understood pathophysiological pathways, minocycline has potential as an adjunctive treatment in psychiatry. To date there have been promising clinical indications that minocycline may be a useful treatment in psychiatry, albeit from small trials most of which were not placebo controlled. Case reports of individuals with schizophrenia, psychotic symptoms and bipolar depression have shown serendipitous benefits of minocycline treatment on psychiatric symptoms. Minocycline has been trialled in open-label or small randomized controlled trials in psychiatry. Results vary, with findings supporting use in schizophrenia, but showing less benefit for nicotine dependence and obsessive-compulsive disorder. Given the limited data from rigorous clinical trials, further research is required. However, taken together, the current evidence suggests minocycline may be a promising novel therapy in psychiatry.