BackgroundMinocycline, an antibiotic with anti-inflammatory, antioxidant, and neuroprotective properties, has been used for treating psychiatric disorders in research. This systematic review aimed to evaluate the efficacy and tolerability of minocycline in patients having depression with or without treatment-resistance.MethodsElectronic databases including Embase, PubMed, and the Cochrane library were searched for relevant studies published up to October 17, 2022. The primary efficacy outcome was the change in depression severity scores and the secondary efficacy outcomes included the changes in Clinical Global Impression (CGI) and Beck Depression Inventory (BDI) scores and the incidence of response and partial response. Safety outcomes were evaluated based on the incidence of classified adverse events and all-cause discontinuation.ResultsFive studies with 374 patients were selected for analysis. The minocycline group demonstrated a significant reduction in depression severity scale (standardized mean difference [SMD]: −0.59, 95% confidence interval [CI]: −0.98 to −0.20, P = 0.003) and CGI (SMD: −0.28, 95% CI: −0.56 to −0.01, P = 0.042) scores; however, no statistical difference was found in terms of the BDI score, response, and partial response. No significant differences were found between the groups in terms of adverse events (other than dizziness) and discontinuation rates. Subgroup analysis showed that minocycline was also effective in reducing depression severity scores in treatment-resistant depression (SMD: −0.36, 95% CI: −0.64 to −0.09, P = 0.010). Subgroup analysis of Hamilton Depression Rating Scale (17-item) scores showed a statistical difference in response in patients with depression (relative risk: 2.51, 95% CI: 1.13 to 5.57, P = 0.024).ConclusionsMinocycline may improve depressive symptoms and augment response to treatment in patients with depression irrespective of treatment-resistance. However, clinical trials with large sample sizes are warranted for evaluating long-term outcomes with minocycline.Systematic review registrationhttps://inplasy.com/inplasy-2022-12-0051/.

Participants: patients diagnosed by the guideline of the Diagnostic and Statistical Manual for Mental Disorders. Patients with major depressive disorder who did not get relieved from current antidepressant treatments were defined as treatmentresistant depression. (2) Intervention: depressive patients who were treated by minocycline. (3) Comparison: depressive patients who were treated by placebo. (4) Outcomes: primary outcome was the INPLASY 1 International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY PROTOCOL Efficacy and tolerability of minocycline in depressive patients with or without treatment-resistant: a meta-analysis of randomized controlled trial

Review question / Objective: (a) population: patients diagnosed as major depressive disorder or postpartum depression according to standard diagnostic criteria; ( b ) i n t e r v e n t i o n : p a t i e n t s re c e i v e d zuranolone were considered intervention group; (c) comparison: patients received placebo were considered comparsion group; (d) outcome: the primary outcome was the change of depressive severity scores. Secondary efficacy outcomes included response and remission after the treatment; safety outcomes were adverse events; (e) study design: only randomized controlled trials were included. Condition being studied: Depression is a c h ro n i c m e n t a l d i s o rd e r w i t h h i g h prevalence, which may also result in INPLASY 1

e v i e w q u e s t i o n / O b j e c t i v e ( 1 ) Participants: individuals aged 18 to 65 who h a v e b e e n d i a g n o s e d w i t h m a j o r depressive disorder; (2) Intervention: patients who were administered cariprazine in addition to their antidepressant medication; (3) Comparison: patients who received a combination of placebo and antidepressant medication; (4) Outcomes: the effectiveness outcomes included the evaluation of changes in various assessment scales, such as the Montgomery-Asberg Depression Rating Scale, the Hamilton Depression Scale (17 items), the Clinical Global Impressions severity, the Clinical Global Impressions improvement, the MADRS response, the MADRS remission, and the CGI-I response. Safety results encompassed the occurrence of adverse events and serious major adverse events;(5) study type: study type was randomized clinical trials. Condition being studiedThe objective of this study is to explore the efficacy and safety of cariprazine as an adjunctive treatment for major depressive disorder. Current approaches for patients with insufficient response to first-line antidepressants include combination therapy using multiple antidepressants concurrently, as well as t h e u s e o f m o o d s t a b i l i z e r s o r a t y p i c a l antipsychotics to enhance the effectiveness of ADTs. Cariprazine has shown promise as an adjunctive therapy with antidepressants for major depressive disorder. This study involved a comprehensive literature review of cariprazine, utilizing databases such as Embase, PubMed, and the Cochrane Library. Through the comparison of these trials, the aim of this study is to provide valuable insights into the effectiveness of adjunctive cariprazine in managing major depressive disorder.

BackgroundChronic subdural hematoma (CSDH) is a neurosurgical condition with high prevalence. Many surgical approaches are recommended for treating CSDH, but there needs to be a consensus on the optimal technique. This network meta-analysis (NMA) compared the efficacy and safety of different surgical treatments for CSDH.MethodsElectronic databases, including PubMed, Embase, and the Cochrane Library, were searched for relevant studies up to February 2023. An NMA was performed to compare the outcomes of patients with CSDH treated by single-hole or double-hole craniotomy (SBHC and DBHC, respectively), twist-drill craniotomy (TDC), mini-craniotomy, and craniotomy. The NMA protocol was registered at INPLASY (registration no. 202320114).ResultsThe NMA included 38 studies with 7,337 patients. For efficacy outcomes, DBHC showed the highest surface under the cumulative ranking area (SUCRA) values for recurrence (96.3%) and reoperation (87.4%) rates. DBHC differed significantly from mini-craniotomy in recurrence rate (odds ratio [OR] = 0.58, 95% confidence interval [CI]: 0.35, 0.97) and from SBHC (OR = 0.48, 95% CI: 0.25, 0.91) and TDC (OR = 0.40, 95% CI: 0.20, 0.82) in reoperation rate. For operative time, TDC was superior to SBHC (mean difference [MD] = −2.32, 95% CI: −3.78 to −0.86), DBHC (MD = −3.61, 95% CI: −5.55, −1.67), and mini-craniotomy (MD = −3.39, 95% CI: −5.70, −1.08). Patients treated by TDC had a shorter hospital stay than those treated by SBHC (MD = −0.82, 95% CI: −1.51, −0.12). For safety outcomes, there were no significant differences between groups in mortality and complication rates; however, mini-craniotomy (79.8%) and TDC (78.1%) had the highest SUCRAs.ConclusionDBHC may be the most effective surgical treatment for CSDH based on the low recurrence and reoperation rates, although all examined techniques were relatively safe.Systematic review registrationhttps://inplasy.com/inplasy-2023-2-0114/