title: A double-blind, randomized study of minocycline for the treatment of negative and cognitive symptoms in early-phase schizophrenia.
abstract: BACKGROUND
  Current antipsychotics have only a limited effect on 2 core aspects of schizophrenia: negative symptoms and cognitive deficits. Minocycline is a second-generation tetracycline that has a beneficial effect in various neurologic disorders. Recent findings in animal models and human case reports suggest its potential for the treatment of schizophrenia. These findings may be linked to the effect of minocycline on the glutamatergic system, through inhibition of nitric oxide synthase and blocking of nitric oxide-induced neurotoxicity. Other proposed mechanisms of action include effects of minocycline on the dopaminergic system and its inhibition of microglial activation.
  
  
  OBJECTIVE
  To examine the efficacy of minocycline as an add-on treatment for alleviating negative and cognitive symptoms in early-phase schizophrenia.
  
  
  METHODS
  A longitudinal double-blind, randomized, placebo-controlled design was used, and patients were followed for 6 months from August 2003 to March 2007. Seventy early-phase schizophrenia patients (according to DSM-IV) were recruited and 54 were randomly allocated in a 2:1 ratio to minocycline 200 mg/d. All patients had been initiated on treatment with an atypical antipsychotic < or = 14 days prior to study entry (risperidone, olanzapine, quetiapine, or clozapine; 200-600 mg/d chlorpromazine-equivalent doses). Clinical, cognitive, and functional assessments were conducted, with the Scale for the Assessment of Negative Symptoms (SANS) as the primary outcome measure.
  
  
  RESULTS
  Minocycline was well tolerated, with few adverse events. It showed a beneficial effect on negative symptoms and general outcome (evident in SANS, Clinical Global Impressions scale). A similar pattern was found for cognitive functioning, mainly in executive functions (working memory, cognitive shifting, and cognitive planning).
  
  
  CONCLUSIONS
  Minocycline treatment was associated with improvement in negative symptoms and executive functioning, both related to frontal-lobe activity. Overall, the findings support the beneficial effect of minocycline add-on therapy in early-phase schizophrenia.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00733057.
authors.affiliation: The Emotion-Cognition Research Center, The Shalvata Mental Health Care Center, P.O.B. 94. Hod-Hasharon, Israel. ylevk@clalit.org.il
authors.forename: Yechiel
authors.initials: Y
authors.lastname: Levkovitz
authors.forename: Shlomo
authors.initials: S
authors.lastname: Mendlovich
authors.forename: Sharon
authors.initials: S
authors.lastname: Riwkes
authors.forename: Yoram
authors.initials: Y
authors.lastname: Braw
authors.forename: Hana
authors.initials: H
authors.lastname: Levkovitch-Verbin
authors.forename: Gilad
authors.initials: G
authors.lastname: Gal
authors.forename: Shmuel
authors.initials: S
authors.lastname: Fennig
authors.forename: Ilan
authors.initials: I
authors.lastname: Treves
authors.forename: Shmuel
authors.initials: S
authors.lastname: Kron
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects; D003071:Cognition / Q000187:drug effects*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008911:Minocycline / Q000008:administration & dosage* / Q000009:adverse effects; D010919:Placebos; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D010919:Placebos; D008911:Minocycline