Antibiotic may improve outcomes for depression in people with low level inflammation
Minocycline, a widely used antibiotic with anti-inflammatory properties, shows greater improvement in depressive symptoms in patients with treatment resistant depression with low-grade peripheral inflammation
2021-01-28
(Press-News.org) King's College London researchers have found evidence that minocycline, a widely used antibiotic with anti-inflammatory properties, gave greater improvement in depressive symptoms in patients with treatment resistant depression with low-grade peripheral inflammation.
Improvement in depressive symptoms
In a four-week randomised clinical MINDEP (MINocycline in DEPression) trial, 39 patients with major depressive disorder were recruited from services linked to South London and Maudsley NHS Foundation Trust (SLaM) and via public advertisement.
The trial took place at the NIHR / Wellcome Trust King's Clinical Research Facility at King's College Hospital. The patients, who were taking their routine antidepressant treatment, were split into two groups, one group took daily a placebo (sugar pill) tablet while the other group took daily minocycline alongside their routine treatment for 4 weeks.
Both groups showed similar, significant improvement in depressive symptoms as measured by the Hamilton Depression (HAM-D) Rating Scale. However, patients with higher C-reactive protein (CRP) levels, indicating low-grade inflammation, showed greater improvement in their depressive symptoms when taking minocycline.
Author Dr Valeria Mondelli, Clinical Reader in Psychoneuroimmunology at Institute of Psychiatry, Psychology & Neuroscience, King's College London, and Principal Investigator of the trial said: "Our findings are very exciting because we are showing that patients with increased levels of C reactive protein (an inflammatory biomarker) show a good response in terms of reduction of depressive symptoms following treatment with minocycline. Of the many patients with depression who do not respond to usual antidepressant treatment, we have shown in previous studies that in at least two thirds of patients this could be due to the increased levels of inflammation. Now, with this study, we are identifying a potential new effective treatment for these patients."
Predicting response
Patients underwent a blood sample to measure biological markers and a clinical assessment at the baseline visit and within 14 days the trial ending.
Researchers also found that levels of two biological markers, CRP and IL-6, can be used to predict minocycline response in depression. The study identified a specific threshold of CRP levels which is associated with the antidepressant effect of minocycline treatment. Another inflammatory marker, interferon-gamma, was reduced by the treatment with minocycline but not by placebo, suggesting specific pathways mediating the effects of minocycline on depressive symptoms.
Dr Mondelli added "We also identified the threshold of CRP levels that is associated with response to this anti-inflammatory treatment. This is very important as we may be able to identify with an easy blood test those patients who are going to benefit from treatment with an anti-inflammatory medication which is already used for other medical conditions and therefore easily available."
Dr Maria Antonietta Nettis, lead author and Clinical Research Associate at Institute of Psychiatry, Psychology & Neuroscience, King's College London said: "Integrating the measurement of biological markers such as CRP in patients' first assessments could help identifying potential responders to minocycline, which could be a relatively safe and well-tolerated addition to treatment in immune-related depression.
Although replications in larger samples are needed, we believe our study has a potentially important clinical impact, as we moved a step towards the identification of personalized treatments for Major depressive disorder (MDD)."
INFORMATION:
The National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) funded study was published today (TBC) in Neuropsychopharmacology.
Notes to editors
Contact
To receive a copy of the embargoed paper or to arrange interviews please contact the Communications team at NIHR Maudsley BRC:
Alex Booth, Communications and Engagement Manager, NIHR Maudsley Biomedical Research Centre, Tel 020 7848 0495 alex.booth@kcl.ac.uk
Serena Rianjongdee, Communications and Engagement Officer, NIHR Maudsley Biomedical Research Centre, Tel 020 7848 2137 serena.rianjongdee@kcl.ac.uk
The National Institute for Health Research (NIHR)
NIHR is the nation's largest funder of health and care research. The NIHR:
Funds, supports and delivers high quality research that benefits the NHS, public health and social care
Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
Partners with other public funders, charities and industry to maximise the value of research to patients and the economy
The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government. http://www.nihr.ac.uk/
About King's College London and the Institute of Psychiatry, Psychology & Neuroscience
King's College London is one of the top 10 UK universities in the world (QS World University Rankings, 2020) and among the oldest in England. King's has more than 31,000 students (including more than 12,800 postgraduates) from some 150 countries worldwide, and some 8,500 staff.
The Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London is the premier centre for mental health and related neurosciences research in Europe. It produces more highly cited outputs (top 1% citations) on mental health than any other centre (SciVal 2019) and on this metric we have risen from 16th (2014) to 4th (2019) in the world for highly cited neuroscience outputs. World-leading research from the IoPPN has made, and continues to make, an impact on how we understand, prevent and treat mental illness and other conditions that affect the brain.
http://www.kcl.ac.uk/ioppn @KingsIoPPN
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[Press-News.org] Antibiotic may improve outcomes for depression in people with low level inflammation
Minocycline, a widely used antibiotic with anti-inflammatory properties, shows greater improvement in depressive symptoms in patients with treatment resistant depression with low-grade peripheral inflammation
