InvisibleEye
Bluelighter
Hi there, I was putting up new articles on the OD Case Studies thread when I came across this very recent article on ScienceDirect. It was irrelevant to the OD thread but I thought it might be of interest in this forum...
A case of methamphetamine use disorder treated with the antibiotic drug minocycline
Yuko Tanibuchi, Minoru Shimagami, Goro Fukami et al. (Jan. 2010)
Ms. A was a 17-year-old Japanese female. At the age of 12, she started to use methamphetamine by daily intravenous injection. A few months after the onset of drug use, she experienced hallucinations (e.g., seeing insects and hearing voices) and exhibited unstable emotions and aggressive behaviors. This led the patient to stop using methamphetamine for 5 months, after which the troubling symptoms disappeared (i.e., within several months). At the age of 15, the patient again started to use methamphetamine intravenously. The frequency of methamphetamine injection quickly increased up to four or five times a day. At the age of 17, the patient's hallucinations had substantially worsened, and she again stopped using methamphetamine. However, the hallucinations persisted after this second cessation of drug use. Under the influence of these hallucinations, the patient exhibited aggressive behaviors and withdrew socially. As a result, the patient's mother brought her to our clinic, 7 months after the patient had stopped using methamphetamine.
At her first visit, the patient expressed having a chronically depressed mood, suicidal ideation, appetite loss and insomnia, in addition to the psychiatric symptoms noted above. She had no history of psychiatric disorder prior to the use of methamphetamine. No abnormalities were identified on physiological or neurological examinations, nor were there any abnormal findings from routine laboratory examinations. The patient was diagnosed with methamphetamine-related psychotic disorder according to the ICD-10 criteria. The total score on the Brief Psychiatric Rating Scale (BPRS) was 38. We started risperidone treatment at 3 mg/day, sulpiride at 150 mg/day and nitrazepam at 10 mg/day. However, this treatment protocol induced adverse reaction (e.g., akathisia) in the central nervous system (CNS), and therefore risperidone was switched to olanzapine at 10 mg/day. Furthermore, trazodone (50 mg/day) and lorazepam (3 mg/day) were added to treat the patient's unstable emotions and insomnia; this resulted in an improvement of the insomnia, but not of the remaining symptoms, in particular, the auditory hallucinations. We then attempted to increase the dose of olanzapine, but CNS adverse reactions once again appeared, and we were therefore unable to increase the olanzapine dosage. Although the patient tried taking sertraline, it was not an effective treatment for her symptoms. At this point, 2 months since the initial administration of olanzapine, the patient's BPRS score was 34. Therefore, we added minocycline to the treatment regimen (100 mg/day bid, morning and evening). Two weeks after the addition of minocycline, the patient's hallucinations had gradually improved. Moreover, with the amelioration of these symptoms, the patient's social withdrawal and aggressive behaviors also gradually disappeared. No new adverse reactions to minocycline were observed. Three months after the addition of minocycline to the patient's treatment regimen, her BPRS scores had decreased to 24.
In this case study, we report that minocycline was an effective treatment for a Japanese female patient with methamphetamine-related psychotic disorder. To the best of our knowledge, this is the first report demonstrating that minocycline could be effective against methamphetamine-related psychotic disorder. In the present patient, the dominant symptoms were hallucinations that had appeared with methamphetamine use; these symptoms persisted long after the patient had stopped using methamphetamine. In spite of the administration of various antipsychotic drugs, the patient's symptoms did not improve. It should be noted that the antipsychotic dosages were limited due to adverse side-effects. However, minocycline was found to successfully treat the patient's symptoms over the course of several weeks.
The course of illness and symptomatic profile of the present case meet the ICD-10 criteria for methamphetamine-related psychotic disorder, since the primary symptom, auditory hallucinations, appeared during and after cessation of the use of methamphetamine, and there were no apparent delusions. However, it should be noted that this patient could have schizophrenia. Furthermore, the alleviation of symptoms seen in this case might have been due to some coincidental event or to the concomitant use of antipsychotic medications, rather than to the direct effect of minocycline. It has also been shown that minocycline significantly reduces hallucinatory symptoms observed in patients with schizophrenia. To clarify this important issue, larger studies will be needed to investigate the efficacy of minocycline monotherapy to treat the symptoms of methamphetamine-related psychotic disorders.
At present, the precise mechanism(s) remains obscure which might account for the efficacy of minocycline at treating methamphetamine-related psychotic disorder. However, the findings of the present case suggest that minocycline could serve as a candidate therapy in clinical trials to develop novel treatment regimens for methamphetamine-induced disorders.
A case of methamphetamine use disorder treated with the antibiotic drug minocycline
Yuko Tanibuchi, Minoru Shimagami, Goro Fukami et al. (Jan. 2010)
Ms. A was a 17-year-old Japanese female. At the age of 12, she started to use methamphetamine by daily intravenous injection. A few months after the onset of drug use, she experienced hallucinations (e.g., seeing insects and hearing voices) and exhibited unstable emotions and aggressive behaviors. This led the patient to stop using methamphetamine for 5 months, after which the troubling symptoms disappeared (i.e., within several months). At the age of 15, the patient again started to use methamphetamine intravenously. The frequency of methamphetamine injection quickly increased up to four or five times a day. At the age of 17, the patient's hallucinations had substantially worsened, and she again stopped using methamphetamine. However, the hallucinations persisted after this second cessation of drug use. Under the influence of these hallucinations, the patient exhibited aggressive behaviors and withdrew socially. As a result, the patient's mother brought her to our clinic, 7 months after the patient had stopped using methamphetamine.
At her first visit, the patient expressed having a chronically depressed mood, suicidal ideation, appetite loss and insomnia, in addition to the psychiatric symptoms noted above. She had no history of psychiatric disorder prior to the use of methamphetamine. No abnormalities were identified on physiological or neurological examinations, nor were there any abnormal findings from routine laboratory examinations. The patient was diagnosed with methamphetamine-related psychotic disorder according to the ICD-10 criteria. The total score on the Brief Psychiatric Rating Scale (BPRS) was 38. We started risperidone treatment at 3 mg/day, sulpiride at 150 mg/day and nitrazepam at 10 mg/day. However, this treatment protocol induced adverse reaction (e.g., akathisia) in the central nervous system (CNS), and therefore risperidone was switched to olanzapine at 10 mg/day. Furthermore, trazodone (50 mg/day) and lorazepam (3 mg/day) were added to treat the patient's unstable emotions and insomnia; this resulted in an improvement of the insomnia, but not of the remaining symptoms, in particular, the auditory hallucinations. We then attempted to increase the dose of olanzapine, but CNS adverse reactions once again appeared, and we were therefore unable to increase the olanzapine dosage. Although the patient tried taking sertraline, it was not an effective treatment for her symptoms. At this point, 2 months since the initial administration of olanzapine, the patient's BPRS score was 34. Therefore, we added minocycline to the treatment regimen (100 mg/day bid, morning and evening). Two weeks after the addition of minocycline, the patient's hallucinations had gradually improved. Moreover, with the amelioration of these symptoms, the patient's social withdrawal and aggressive behaviors also gradually disappeared. No new adverse reactions to minocycline were observed. Three months after the addition of minocycline to the patient's treatment regimen, her BPRS scores had decreased to 24.
In this case study, we report that minocycline was an effective treatment for a Japanese female patient with methamphetamine-related psychotic disorder. To the best of our knowledge, this is the first report demonstrating that minocycline could be effective against methamphetamine-related psychotic disorder. In the present patient, the dominant symptoms were hallucinations that had appeared with methamphetamine use; these symptoms persisted long after the patient had stopped using methamphetamine. In spite of the administration of various antipsychotic drugs, the patient's symptoms did not improve. It should be noted that the antipsychotic dosages were limited due to adverse side-effects. However, minocycline was found to successfully treat the patient's symptoms over the course of several weeks.
The course of illness and symptomatic profile of the present case meet the ICD-10 criteria for methamphetamine-related psychotic disorder, since the primary symptom, auditory hallucinations, appeared during and after cessation of the use of methamphetamine, and there were no apparent delusions. However, it should be noted that this patient could have schizophrenia. Furthermore, the alleviation of symptoms seen in this case might have been due to some coincidental event or to the concomitant use of antipsychotic medications, rather than to the direct effect of minocycline. It has also been shown that minocycline significantly reduces hallucinatory symptoms observed in patients with schizophrenia. To clarify this important issue, larger studies will be needed to investigate the efficacy of minocycline monotherapy to treat the symptoms of methamphetamine-related psychotic disorders.
At present, the precise mechanism(s) remains obscure which might account for the efficacy of minocycline at treating methamphetamine-related psychotic disorder. However, the findings of the present case suggest that minocycline could serve as a candidate therapy in clinical trials to develop novel treatment regimens for methamphetamine-induced disorders.
