Treating OCD with Minocyline

[bobh]

We also were on minocycline for an extended period last year (months), and did not have a positive effect. We actually very slowly and progressively got worse then and later (while off it) - I doubt if the minocycline can be reasonably blamed.

 

When I first read the original article posted some time back, I was annoyed that they didn't distinguish between the "traditional" effect of abx on a PAN/PANDAS child and this new effect. If they don't specifically talk about and exclude PANS/PANDAS patients from their study (and do that well - it has been badly done), then how do we know if any improvement is due to how abx works for that class of patients? PANDAS/PANS as a possibility was raised by some commenting to the article.

[MomWithOCDSon]

Bobh --

 

I think your point about abx and the specific nature of the patients in the study is a good one. That said, IMHO, inflammatory and/or immune dysfunction-based mental "illness" is far more prevalent than most of the western medical community -- and/or the general public -- would even dare to believe at this point, so your study group would most likely always be subject to some variability in that regard. I don't know that ruling out or dividing study groups between those identified as PANDAS/PANs and those specifically identified as non-PANDAS/PANs would be possible or, if possible, actually define anything in the end. Quite likely, there are many, many folks out there who DO, in fact, suffer from inflammatory and/or immune dysfunction as root causes (or at the very least, "enhancers") of their mental disorders but have never been diagnosed and/or have never investigated the possibility.

 

I don't know about minocycline specifically, beyond the studies and articles posted here, but I know that when my DS was on abx and seemed to need them for an extended time period in order for his behavioral gains to hold, I found a lot of research about the other qualities/properties of certain classes of abx, including their anti-inflammatory properties, their glutamate-modulating properties, etc. There have been studies associating positive impacts of various abx (d-cycloserine, augmentin, etc.) for schizophrenia, OCD, autism, bipolar, depression and PTSD.

 

Seems to me that our full understanding of these "accidental benefits" is in its infancy, and there's a lot more to research and uncover in this regard.

 

I'm sorry the mino did not appear to benefit your situation, but hopefully you'll find a course of treatment that is beneficial, if you haven't already.

[bobh]

Nancy, you are right - there is always going to be variability in the subjects of any study, and that is often difficult to deal with.

 

I was specifically annoyed that they were discussing OCD and abx (minocycline) as if this was amazing new ground, without even whispering the word PANDAS in this article (i.e. the first article posted in this thread). I don't believe the researchers themselves could have missed running across PANDAS in their background research, so I concluded that either they didn't believe in PANDAS, or didn't want to get involved something they thought was a hot debate, or the media that published this story took out any reference they made to PANDAS for similar reasons. Whichever it is, all those reasons annoy me.

 

But further to your comment, when significant observational (i.e. not placebo controlled) studies are done, considerable time and effort is spent removing the effect of what they call "confounders". They can adjust results based on known attributes of subsets of the group. This can only be done really well for large sets of data, but they had 80 subjects here. Its one thing to decide to not do anything about a subgroup that likely makes up about 25% of your patients because you don't believe you have enough numbers (I don't think that is so, by the way), but its quite another thing to not acknowledge it at all, especially when what is being done elsewhere for that subgroup is so related to your "new" research (effect of abx for OCD). This point is on top of all the other (i.e. immunomodulatory) effects of abx you point out - that too has been studied before this work was done.

[Ladymavs]

We just started at the 12.5mg zoloft today.  Probably could have gone straight to 25mg as that was the script..but guess that I err on the side of caution.  I think that we may have to drop down the minocycline as I have heard the 200mg is really strong and that could be playing a role in our current flare...who knows!  

[bobh]

When we started Zoloft, we insisted on 2.5mg (it had to be compounded to get that), and the non-believing pediatrician fortunately let us do that, saying "starting low is not controversial".

Well, we had a dramatic positive effect on 2.5mg within 3 days, and because the dose was "sub therapeutic" according to the pediatrician, and acted so fast, he didn't believe it was from the Zoloft.

The reason to start as low as 1/10 the typical starting dose is from Dr. Tanya Murphy's paper here:
https://www.researchgate.net/publication/228785018_Selective_serotonin_reuptake_inhibitor-induced_behavioral_activation_in_the_PANDAS_subtype

There is also other similar supporting suggestions, for example from Dr. Swedo - reference available on request!