Preclinical rodent studies support minocycline as an adjunctive anxiolytic

Anxiety disorders represent a significant public health burden with limited treatment options, particularly amidst the escalating rates observed over the past two decades. While psychological and pharmacological treatments are available, often these treatments do not facilitate complete symptom remission for many individuals. Consequently, there is a pressing need for innovative interventions. Current systematic reviews have provided clinical support for adjunctive minocycline in psychiatry, particularly schizophrenia and major depressive disorder. While anxiety symptoms have been investigated as secondary outcomes, there has been no direct clinical studies of minocycline and anxiety disorders. Additionally, there is no existing literature specifically exploring the biological mechanisms of minocycline relevant to the pathophysiology or presentation of anxiety disorders. This review investigated the potential of minocycline, a tetracycline antibiotic with anti-inflammatory, antioxidant, glutamatergic and neurogenic properties, as a potential treatment for anxiety disorders. Drawing upon existing preclinical literature, we explore the role of microglial activation in anxiety behavior, elucidating the relationship with neurotransmitter dysregulation, synaptic plasticity, and neuroendocrine functions. Preclinical evidence suggests that minocycline may modulate these pathways through its inhibitory effects on microglial activation, thereby mitigating neuroinflammation, restoring neurochemical balance, and alleviate anxious behaviors. Through a comprehensive analysis of available preclinical data, this review aims to inform future research on the potential utility of adjunctive minocycline in managing anxiety disorders. • Despite advances in treatment anxiety disorders remain common and hard to treat. • Minocycline is a novel anti-inflammatory agent with anxiolytic potential. • Inconclusive clinical studies require targeted guidance from preclinical models. • Preclinical evidence suggests sustained minocycline is efficacious and safe.