Adjunctive minocycline for major mental disorders: A systematic review.

Objectives: This meta-analysis of randomized controlled trials (RCTs) examined the efficacy and safety of minocycline for three major mental disorders: schizophrenia, bipolar disorder and major depressive disorder (MDD).

Methods: A systematic literature search of major electronic databases was conducted. Meta-analysis of clinical efficacy as defined by the respective studies, all-cause discontinuation, adverse drug reactions (ADRs) with standardized mean difference (SMD) and risk ratios (RRs) and their 95% confidence intervals (CI) was conducted using random-effects model. Quality assessment was performed with the Jadad scale and Cochrane risk of bias.

Results: Sixteen RCTs (=1357) on minocycline (50-300 mg/day) for schizophrenia (13 RCTs, =1196), bipolar depression (1 RCT, =49), and MDD (2 RCTs, =112) were analyzed separately by diagnosis. Twelve RCTs mentioned randomized allocation specifically; the weighted Jadad scores were 4.0. Adjunctive minocycline outperformed placebo in improving total psychopathology [SMD: -0.45 (95%CI: -0.73, -0.16), =0.002; I=77%], positive [SMD: -0.15 (95%CI: -0.28, -0.02), =0.02; I=0%], negative [SMD: -0.62 (95%CI: -0.95, -0.28), =0.0003; I=85%] and general psychopathology scores [SMD: -0.28 (95%CI: -0.53, -0.03), =0.03; I=59%] in schizophrenia. Minocycline showed no significant effect on depressive and manic symptoms in both bipolar depression and MDD. Minocycline caused significantly less headache (=0.02, number-needed-to-harm=14, 95%CI=5-14) than placebo in schizophrenia. All-cause discontinuation and other ADRs were similar between minocycline and placebo in each diagnostic category.

Conclusion: In this meta-analysis, adjunctive minocycline appeared to be efficacious and safe for schizophrenia. However, the efficacy of adjunctive minocycline for bipolar depression or MDD could not be demonstrated.

Review Registration: PROSPERO: CRD42018102483.