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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 93. This is the beginning of the thread.
Posted by SLS on August 14, 2012, at 9:23:51
In an effort to accelerate my rate of recovery, I have added minocycline. Minocycline is a synthetic tetracycline that, in the past, has been used as an antibiotic. However, it has additional properties that are unrelated to its antibiotic mechanisms.
Minocycline:
1. Is neuroprotective.
2. Reduces brain inflammation
3. Reduces the number of glutamate receptors.
4. Demonstrates antidepressant properties in mouse models of depression.
5. Is reported to act synergistically with noradrenergic antidpressants to treat depression - desipramine (but not fluoxetine).
6. Is reported to act synergistically with NMDA antagonists.
7. Reduces glutamate excitotoxicity by reducing the formation of quinolic acid, a NMDA agonist.
8. Reduces mitochondrial release of cytochrome C.
9. Modulates several signalling pathways.
10. Reduces microglial activation.
11. Has been reported anecdotally to successively treat depression.
12. Reduces the expression of lipopolysaccharide-induced pro-inflammation cytokines, an effect that acts as an antidepressant in animal models.It has been suggested that minocycline might act synergistically with Lamictal to reduce glutamate activity and improve depression.
My current regime:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
lithium 300 mg
Abilify 10 mg
prazosin 8 mg
minocycline 50 mg.I might add N-acetylcysteine (NAC) as an antioxidant and glutamatergic transport modulator. NAC has been used as an augmenting agent in the treatment of bipolar depression.
- Scott
Posted by Phillipa on August 14, 2012, at 10:14:07
In reply to Starting minocycline., posted by SLS on August 14, 2012, at 9:23:51
Scott was just two weeks ago given minocycline for dermatologic perioral dermatitis which I have in addition to ecezema. I was cautioned that it was given in summer instead of doxycyline as the sun reaction not as severe. And it does cross the blood brain barrier. I was also cautioned about dizzyness, and other psychiatric reactions. I took 4 does for a total of two days. The dizzynes was acut and that was on a mere 75mg twice a day. I started on a Friday so could not report these side effects till Monday. I was told to discontinue the antibiotic also had a new rash on right arm. I do know from that experience that it definitely does effect the brain. I was given a clindamyadin and another sulfur liquid to use at night. I will be looking to see if it effects you positively. Was this your idea or a docs? Phillipa
Posted by Phillipa on August 14, 2012, at 10:15:46
In reply to Re: Starting minocycline. » SLS, posted by Phillipa on August 14, 2012, at 10:14:07
I see you are taking only 50mg a day. That is considered a very low dose why did you chose this dose?
Posted by Phillipa on August 14, 2012, at 12:00:13
In reply to Re: Starting minocycline., posted by Phillipa on August 14, 2012, at 10:15:46
Did a search and pub med says this:
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Performing your original search, minocycline for depression, in PubMed will retrieve 34 records.
Biomed Pharmacother. 2008 Jun;62(5):308-11. Epub 2008 Jan 14.Does minocycline have antidepressant effect?
Pae CU, Marks DM, Han C, Patkar AA.
SourceDepartment of Psychiatry, Kangnam St. Mary's Hospital, The Catholic University of Korea College of Medicine, 505 Banpo-Dong, Seocho-Gu, Seoul 137-701, South Korea. chiun.pae@duke.edu
AbstractOnly one-third of patients undergoing monotherapy with an antidepressant achieve remission of their depressive symptoms and gain functional recovery. Therefore, further exploration of antidepressant mechanisms of action is important in order to facilitate the development of antidepressants with new modes of action. Preclinical and clinical studies have demonstrated that major depression is associated with impaired inflammatory responses and deficient neuroprotection. In this regard, we propose that the second-generation tetracycline "minocycline" may hold a potential as a new treatment for major depression. Emerging findings in animal and human studies of minocycline reveal that it has antidepressant-like neuroprotective and anti-inflammatory actions, and minocycline has been shown to perform as an antidepressant in an accepted animal model (forced swimming test). Anecdotal evidence supports minocycline's efficacy for augmentation of antidepressants in major depressive disorder. The following review describes the evidence supporting the consideration of minocycline as a potential antidepressant. We suggest that minocycline may be particularly helpful in patients with depression and comorbid cognitive impairment, as well as depression associated with organic brain disease. We also describe the antinociceptive effect of minocycline and propose a role for minocycline in the treatment of patients with major depression and prominent somatic discomfort and somatoform spectrum disorders. The lack of clinical studies of minocycline for depression is noted. Further studies of the potential therapeutic mechanism of minocycline and its therapeutic implications for major depression are warranted, and may substantially contribute to the development of newer and more effective antidepressants
Posted by bleauberry on August 14, 2012, at 16:06:32
In reply to Starting minocycline., posted by SLS on August 14, 2012, at 9:23:51
Hey that's cool Scott. That's a whole new avenue. Doxy has most of the same attributes as mino and I was on it for several months. It was sort of nasty at first, but after a couple weeks it was easy to take. I started mino a few years ago and couldn't tolerate it. I know now that was not what happened. It was a herxheimer reaction. It was before I even knew I had Lyme. I thought I had depression. That was just a symptom.
Mino is intracellular, so over time it can eradicate bacteria that live inside cells and cause illness. That is important because it covers a wide span of possibilities, many we know and many we don't I'm sure. They all have depression as a common denominator.
If you get feeling really bad beginning about 3 to 7 days in, flu like, much worse depression, really tired, achy, butterflies in the stomach type anxiety, bizarreness....most likely a herxheimer reaction. People can have violent herxes from mino even at doses as low as 25mg once every two days. If anything resembling a herx happens, our choice is to tolerate it and deal with it, or back off on the dose, stop it temporarily, repeat when you feel recovered from in it, in my experience that's about 2 days. Repeat over and over until it becomes easy to handle, which it will. It's sort of like peeling layers of onion. The problem with toughing it and just tolerating it is that real neurological damage can be done by the severe inflammation response happening at that time. Overall mino is one of the easiest to tolerate, after the initial break in period, and effective on a wide range of health issues. The risks are low enough that it and doxy are commonly prescribed for months to treat acne.
If in the first day or two you feel better than you've felt in a long time, and then in another week you feel worse than before, that is diagnostic.
Hopefully none of this will matter, because you'll find it easy to tolerate with no bad reactions.
Anyway, mino, I like that idea.
Posted by Slabicki on August 14, 2012, at 16:22:00
In reply to Starting minocycline., posted by SLS on August 14, 2012, at 9:23:51
Hi Scott,
That's good that you still have options.
Please let us know how it goes.Slabicki
Posted by Tomatheus on August 14, 2012, at 16:52:31
In reply to Re: Starting minocycline. » SLS, posted by Slabicki on August 14, 2012, at 16:22:00
> Please let us know how it goes.
>
> SlabickiYes Scott, please keep us posted on how your trial goes, and good luck!
Tomatheus
Posted by SLS on August 14, 2012, at 17:30:30
In reply to Re: Starting minocycline., posted by bleauberry on August 14, 2012, at 16:06:32
Thank you VERY much!
What was it about minocycline that you found difficult to tolerate?
Good old Herxheimer. My doctor and I discussed this.
A friend of mine is also trying minocycline for depression. It produced remission for the first two weeks. In the third week, this person has experienced chronic yawning and somnolence, although the remission remains intact. During the first two days of treatment, he/she felt uncomfortably overstimulated - "wired". Upon dosage reduction, this state dissipated. The depression remitted a few days later, although dosing might still need to be tweaked.
What do you make of the yawning and somnolence that emerged two weeks into treatment? I did not think that these were manifestations of a Herxheimer reaction because the depression did not worsen. I am wrong to have made this assumption. Some of the symptoms do overlap with the Herxheimer reaction. I have reason to believe that something else is going on neurobiologically, but I will consider Herxheimer as a possible explanation, and relay to this person your excellent insights.
FYI, many of the properties of minocycline that I listed are not found with doxycycline or tetracycline. I'll see if I can find a citation for this. I'm sure you recall that I tried doxycycline for a few months without success. I feel that minocycline is different enough from doxycycline to warrant a trial.
Thanks again.
- Scott
Posted by SLS on August 14, 2012, at 20:53:57
In reply to Re: Starting minocycline. - Thank you! » bleauberry, posted by SLS on August 14, 2012, at 17:30:30
> FYI, many of the properties of minocycline that I listed are not found with doxycycline or tetracycline. I'll see if I can find a citation for this.
--------------------------------------
Effects of three tetracyclines on NGF-induced neurite outgrowth in PC12 cells: Translation Initiation Factor eIF4AI
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0015430
------------------------------------
- Scott
Posted by SLS on August 14, 2012, at 20:56:21
In reply to Re: Starting minocycline., posted by Phillipa on August 14, 2012, at 12:00:13
> Did a search and pub med says this:
Thanks, Phillipa.
:-)
- Scott
Posted by Phillipa on August 14, 2012, at 21:27:05
In reply to Re: Starting minocycline. » Phillipa, posted by SLS on August 14, 2012, at 20:56:21
Scott since it does cross the blood brain barrier two dermatologists said the same it can cause dizziness. And it did with me. Headache also. Makes me wonder if the two years of biaxin lr and why I felt so good was because of inflammation from lymes and that taste gone after stopping it per doc was that now the lyme cysts attacked the nerves of nose. As four taste & smell docs all said same virus attacked neurons of nose. Phillipa
Posted by Raisinb on August 15, 2012, at 0:30:57
In reply to Starting minocycline., posted by SLS on August 14, 2012, at 9:23:51
Good luck with it, Scott. I'll be interested to hear the results.
Posted by SLS on August 15, 2012, at 7:14:43
In reply to Re: Starting minocycline. » SLS, posted by Raisinb on August 15, 2012, at 0:30:57
> Good luck with it, Scott.
Thanks. I appreciate that.
> I'll be interested to hear the results.
I will keep you apprised of my progress. It might take a few weeks, although I have seen it work almost immediately.
Although I am using minocycline as an augmenter, some investigators will undoubtedly design clinical studies using it as monotherapy. Results of such studies might be disappointing, although it does display antidepressant properties in animial models of depression (forced-swim test). Minocycline might best be used in conjunction with noradrenergic antidepressants. It makes desipramine work better in some experiments. It acts similarly with anti-glutamate drugs. Because of this, I like the idea of combining minocycline with nortriptyline and Lamictal, a pro-noradrenergic and a anti-glutamergic drug repectively.
- Scott
Posted by b2chica on August 15, 2012, at 15:55:47
In reply to Starting minocycline., posted by SLS on August 14, 2012, at 9:23:51
Man, everything you listed makes it sound like a wonder drug.
maybe if...when the pristiq starts to die out again i could use Minocycline in my regimane? is it synergistic with SNRI's?
current regimen:100mg pristiq
20mg adderall TID
Gabapentin 300mg-1800mg
perphenazine 4mg night
xanax 1mg night (or during day if needed)
Melatonin 10mg night (just started it up again last week)
Posted by SLS on August 15, 2012, at 16:37:09
In reply to Re: Starting minocycline. » SLS, posted by b2chica on August 15, 2012, at 15:55:47
> Man, everything you listed makes it sound like a wonder drug.
As time goes on, scientists discover more and more properties of the drugs we use to treat depression. Minocycline sure does a lot of different things. I doubt that it will be a wonder drug, but I am sure that a certain percentage of people will respond to it.
> maybe if...when the pristiq starts to die out again i could use Minocycline in my regimane? is it synergistic with SNRI's?
I can't say for sure. I have an article that indicates minocycline would work well with noradrenergic drugs. One of the tests they used found it to be synergistic with desipramine, but not Prozac. Other tests do not make this distinction. Preclinical tests show that minocycline monotherapy produces antidepressant effects in mice. My guess is that minocycline would work well with higher doses of SNRIs.
Have you ever combined Pristiq with Wellbutrin? They often go well together. Wellbutrin can also be effective for ADD.
Have you tried Lamictal?
> current regimen:
>
> 100mg pristiq
> 20mg adderall TID
> Gabapentin 300mg-1800mg
> perphenazine 4mg night
> xanax 1mg night (or during day if needed)
> Melatonin 10mg night (just started it up again last week)Some people get depressed when they take melatonin. I imagine this is relatively infrequent, though.
By the way, how high have you gone with Effexor?
- Scott
Posted by Phillipa on August 15, 2012, at 20:26:37
In reply to Re: Starting minocycline. » b2chica, posted by SLS on August 15, 2012, at 16:37:09
Is the monocycline only useful in bipolar depression? And if not using as an antibiotic wouldn't this be considered to possibly make yourself antibiotic resistant and hence if got physically ill antibiotics wouldn't work? Phillipa
Posted by Jeroen on August 16, 2012, at 4:32:04
In reply to Starting minocycline., posted by SLS on August 14, 2012, at 9:23:51
is it safe for me to take this also? because i had a psychotic reaction to lamictal few years ago
Posted by SLS on August 16, 2012, at 6:45:24
In reply to TO SLS, posted by Jeroen on August 16, 2012, at 4:32:04
> is it safe for me to take this also? because i had a psychotic reaction to lamictal few years ago
I imagine people will have different reactions to minocycline, as is true with other psychotropics. I know it can have an energizing effect early in treatment. Is this an indicator that it can precipitate psychosis in vulnerable individuals? I can't be sure. However, it can reduce the behavioral effects of amphetamine and methamphetamine. This would suggest to me that minocycline can act to reduce psychosis, not trigger it.
http://www.ncbi.nlm.nih.gov/pubmed/20851278
You are down to so few alternatives, though, that it might be worth the risk to try minocycline. It has been researched more extensively for schizophrenia than it has for depressive disorders (MDD and BD). It is known to improve negative symptoms (apathy, emotional blunting, and social withdrawal) and cognitive function, and is usually administered as an adjunct to antipsychotic drugs. I could not find any reports of minocycline producing psychosis on Medline/Pubmed.
You might be interested in this abstract about Lamictal-induced psychosis:
http://www.ncbi.nlm.nih.gov/pubmed/17485241
Keep in mind that there were only 6 cases of emergent psychosis in the 1400 people treated for epilepsy. Unfortunately, you might be one of those 6.
Also, there is this:
http://www.ncbi.nlm.nih.gov/pubmed/17485241
This study contradicts several others. It reports that Lamictal is not effective for treating schizophrenia.
- Scott
Posted by Jeroen on August 16, 2012, at 9:47:17
In reply to Re: TO SLS » Jeroen, posted by SLS on August 16, 2012, at 6:45:24
I wish you good luck with the minocycline
i will find a doctor who wants to prescribe this to me too :)
Posted by b2chica on August 16, 2012, at 12:21:41
In reply to Re: Starting minocycline. » b2chica, posted by SLS on August 15, 2012, at 16:37:09
well i'm glad to hear its synergistic with desipramine, as if the pristiq at 100 hadn't worked i was going to switch to that. (or add on) anyway, as i'm on 100 of pristiq maybe it would work well?
i haven't combined pristiq with wellbutrin as i was on wellbutrin about 8 years ago and worked well for one year then pooped out. tried it again three years later (tried two generics and name brand) none of them worked. so i just assumed its completely null for me now?
I was only on Lamictal for about one week. they put me on it while i was in hospital and got off it when went to pdoc as he completely revamped my regimine at that time.
though i tend to not do well on 'mood stabilizers' it actually seems to make my mood cycle? trileptal, topamax, and i cant even think what else i've been on but i think lamictal is always a possibility i guess in the future.
i did notice a drop in mood the first go around on it. but i got some pretty good sleep for the first 2-3 weeks. i just need to get my sleep stabilized so i started it again.
i dont remember how high up i went on effexor, i know i didnt get too high before they had to take me off it. i had SEVERE rapid cycling like every 1-2 days mood change and they were Wild swings! i mean uncontrollable sobbing one day and next day or so i was tingly and on top of the world seeing colors and ideas never could imagine. also felt like i was in a bubble kind of saw myself as unrealistic.
So got off quickly and NEVER looked back. infact i was running out of ideas and it was by my insistance that i tried pristiq, as my then pdoc wanted me to go on lithium and for personal reasons i kept refusing. good thing too cuz pristiq has worked well for quite a few years for me.
Thanks for the input Scott.
i'm doing mostly pretty well on my regimen now, except for some sleep issues. cant get to sleep at night and cant wake up in the morning. so its a matter of shifting what i take and when...
Posted by SLS on August 17, 2012, at 9:56:46
In reply to Starting minocycline., posted by SLS on August 14, 2012, at 9:23:51
So far, so good.
I am not feeling worse. This is a good thing. In fact, the last two days have demonstrated improvement. This has not been characteristic of my more recent mood states. However, I did tweak the dosage of prazosin a few days ago. If I had to guess at this early juncture, I would suspect that I am responding to the addition of minocycline. But then again, I do have that strange personality disorder that presents as incorrigible optimism. I will endeavor to be objective, though.
- Scott
Posted by brynb on August 17, 2012, at 13:45:02
In reply to Starting minocycline., posted by SLS on August 14, 2012, at 9:23:51
Scott-
I find this so interesting. I have an Rx for minocycline from my dermatologist (for breakouts). It's 100mg capsules. I'm thinking of adding it to my current regimen. What's the proper dosage for treating depression/inflammation?
-b
Posted by SLS on August 17, 2012, at 15:21:14
In reply to Re: Starting minocycline. » SLS, posted by brynb on August 17, 2012, at 13:45:02
> Scott-
>
> I find this so interesting. I have an Rx for minocycline from my dermatologist (for breakouts). It's 100mg capsules. I'm thinking of adding it to my current regimen. What's the proper dosage for treating depression/inflammation?
>
> -bMost studies of minocycline to treat psychiatric illness have used 100 - 150 mg/day. I would start at 50 mg once per day for a few days, then 50 mg twice per day thereafter. I really don't have a "feel" for the behavior of this drug in other people yet. However, some people might be too sensitive to starting minocycline at 100 mg/day.
If it turns out that I am currently experiencing the beginnings of an antidepressant response to minocycline, then it is apparent to me that some people will experience an improvement within the first week. I have seen this before with this drug. However, it is important to note that I am taking other psychotropic drugs, including Lamictal and Abilify. Lamictal, in particular, might act in concert with minocycline to disinhibit mesolimbinc dopamine release by reducing glutamate activity in the VTA. The result is increased dopamine activity. I'm sure it's not that simple, though.
- Scott
Posted by Slabicki on August 17, 2012, at 18:13:04
In reply to Re: Starting minocycline. » brynb, posted by SLS on August 17, 2012, at 15:21:14
Hi,
I was just wondering how safe it is to try Minocycline if I have anxiety problem. I mean I'm just cycling from depression to anxiety.Could it increase my anxiety?
Any opinions on this?
Slabicki
Posted by Phillipa on August 17, 2012, at 20:44:47
In reply to Re: Minocycline, is it safe with anxiety?, posted by Slabicki on August 17, 2012, at 18:13:04
I was put on this a few weeks ago for skin at 75mg twice a day. I got headaches, and was dizzy. The dermatologist took me off said very common side effect. Also since I've taken long term antibiotics for lymes disease. I wonder won't I become antibiotic resistant? Phillipa
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