Protocol and Rationale-The Efficacy of Minocycline as an Adjunctive Treatment for Major Depressive Disorder: A Double Blind, Randomised, Placebo Controlled Trial

While current pharmacotherapies are efficacious, there remain a clear shortfall between symptom remission and functional recovery. With the explosion in our understanding of the biology of these disorders, the time is ripe for the investigation of novel therapies. Recently depression is conceptualized as an immune-inflammatory and nitro-oxidative stress related disorder. Minocycline is a tetracycline antibiotic that has anti-inflammatory, pro-oxidant, glutamatergic, neurotrophic and neuroprotective properties that make it a viable target to explore as a new therapy. This double blind, randomised, placebo controlled adjunctive trial will investigate the benefits of 200 mg/day of minocycline treatment, in addition to any usual treatment, as an adjunctive treatment for moderate-severe major depressive disorder. Sixty adults are being randomised to 12 weeks of treatment (with a 4 week follow-up post-discontinuation). The primary outcome measure for the study is mean change on the Montgomery-Asberg Depression Rating Scale (MADRS), with secondary outcomes including the Social and Occupational Functioning Assessment Scale (SOFAS), Clinical Global Impressions (CGI), Hamilton Rating Scale for Anxiety (HAM-A), Patient Global Impression (PGI), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and Range of Impaired Functioning Tool (LIFE-RIFT). Biomarker analyses will also be conducted at baseline and week 12. The study has the potential to provide new treatment targets, both by showing efficacy with a new class of 'antidepressant' but also through the analysis of biomarkers that may further inform our understanding of the pathophysiology of unipolar depression.

Cost analysis of treatment for schizophrenic patients in social security scheme, Thailand

Objective: To determine the cost of treatment for schizophrenic patients in Social Security scheme, Thailand. Methods: The paper reviewed available evidence in Thailand on the cost of schizophrenia treatment in different hospital settings and data of health service utilization obtained from various sources. The sensitivity analysis of direct health care cost of schizophrenia was conducted in social security system, both in outpatient and inpatient services. The cost for schizophrenia coverage per individual social security applicant was estimated in different contexts. Results: The total cost of treatment depends on the service utilization rate and unit cost of treatment. The annual direct health care cost of schizophrenic outpatients in Thai social security scheme was averagely estimated at about 171 million Baht. (Range: 28.5 million to 372 million Baht in sensitivity analysis). The annual direct health care cost of schizophrenic inpatients in Thai social security scheme was averagely estimated about 265.3 million Baht (Range; 22.7 million to 531 million Baht in sensitivity analysis). Aggregation the outpatient and inpatient treatment for schizophrenic employees accounted for 436.5 million Baht/year (Range from 436.5 million to 903 million Baht). The cost for schizophrenia coverage per individual social security applicant was about 48 Baht/year. (Range 5.63 Baht to 99.22 Baht). Conclusion: This study illustrated the cost of schizophrenia treatment in Thai social security scheme in various contexts, which might be useful in planning, preparing, budgeting and decision making. However, the huge societal impacts of schizophrenia should be carefully considered for policy makers.