Effect of Pindolol on Onset of Action of Paroxetine in the Treatment of Major De
Effect of Pindolol on Onset of Action of Paroxetine in the Treatment of Major Depression
Abstract & Commentary
Synopsis: The addition of pindolol (Visken) to paroxetine (Paxil) treatment accelerates the onset of antidepressant response.
Source: Bordet R, et al. Effect of pindolol on onset of action of paroxetine in the treatment of major depression: Intermediate analysis of a double-blind, placebo-controlled trial. Am J Psychiatry 1998;155(10):1346-1351.
Although the newer antidepressant medications are better tolerated and appear to treat a broader spectrum of psychiatric disorders than the older agents, the delayed onset of action remains problematic. Building on prior open data by other investigators, Bordet and colleagues report controlled data evaluating the ability of pindolol to accelerate the onset of antidepressant response to the SSRI paroxetine (Paxil). Pindolol (Visken) is an old beta blocker that is structurally analogous to serotonin. Unrelated to its effect on beta receptors, pindolol is an antagonist at the presynaptic serotonin 1A receptor. This unique property is of theoretical and practical interest because the serotonin 1A receptor is typically down regulated following several weeks of treatment with serotonergic antidepressants. Therefore, Bordet et al and other investigators1,2,3 hypothesize that joint administration of both drugs at the initiation of treatment may hasten the initial antidepressant response. In the current study, patients with major depression who had not previously been treated were randomly assigned for the first 21 days of treatment to treatment with paroxetine 20 mg/d and either pindolol 5 mg TID or placebo. Data are presented for the first 100 patients to complete one month of treatment. In the pindolol plus paroxetine group 48% had a remission of symptoms by day 10, as assessed by standard rating scales, compared to 26% in the paroxetine plus placebo group. There were no differences between the groups from day 15 onward.
Comment by Lauren B. Marangell, MD
This is the first positive double-blind, placebo-controlled trial of pindolol augmentation to accelerate antidepressant response. It should be noted that preclinical data and other less controlled clinical data suggest that pindolol augmentation is also effective in combination with other SSRIs and also nefazodone (Serzone). Open data also suggest that pindolol augmentation may be useful in patients who have failed to respond to an adequate trial of a serotonergic antidepressant, but many clinicians report suboptimal results with this strategy in practice. It is important to note that not all beta blockers produce this effect, and that beta blockers alone are not antidepressants. Although not required for every patient, pindolol augmentation may be useful in select patients, particularly those who might benefit from a beta blocker for other reasons.
References
1. Artigas F, et al. Pindolol induces a rapid clinical improvement of depressed patients treated with serotonin reuptake inhibitor (letter). Arch Gen Psychiatry 1994;51:248-251.
2. Blier P, Bergeron R. Effectiveness of pindolol with selected antidepressant drugs in the treatment of major depression. J Clin Psychopharmacol 1995; 15:217-222.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.