Psycho-Babble Medication Thread 55327

Shown: posts 1 to 10 of 10. This is the beginning of the thread.

 

The case for pindolol as an antidepressant

Posted by SalArmy4me on March 2, 2001, at 8:58:33

I post this from time to time because some people haven't even heard of certain treatment options--so they try other augmentation agents that have less evidence behind them, and work poorly or not at all. Examples of these unproven agents include Omega3s, amantadine, inositol, or all the over-the-counter vitamins, minerals, or herbs--save hypericum.

No augmentation agent will work as well as Lithium. This is the first choice in augmentation according to my doctor and the Harvard Psychiatry Depression Algorithym (http://mhc.com/Algorithms/Depression/). But if you cannot take the side-effects of Lithium, do not have a thyroid deficiency (which exacerbates depression), or have not done well on buspirone, Harvard mentions Visken (rx only: pindolol)--also featured prominently on the New York University Psychiatry website: http://www.med.nyu.edu/Psych/aug/index.html

This treatment for depression is nothing new, actually. Pindolol is a beta-blocker, the only one of its class known to speed up the action of
antidepressants. The main studies done (found on Medline) have used it most effectively with sertraline, although it has been tried and
proven effective with most of the SSRIs, tranylcypromine and moclobemide, and a few of the tricyclics. See Dr. Bob's
Psychopharmacology website (uhs.bsd.uchicago.edu/~bhsiung/tips/tips.html) and look up pindolol for more information.

I promote pindolol because it once made the most dramatic difference in my life. I took 10 mg per day in two divided doses. Drawbacks: 1) It MUST be taken in brand form--not generic. 2) It can cause
stomach-upset. This can be remedied with famotidine, cimetidine, or protonix. 3) It takes as long as antidepressants to work, and 4) it cannot be used in the place of a regular antidepressant/anticonvulsant.
But these drawbacks never convinced me to stop using it.

Best wishes for your full recovery by Easter...

 

Re: The case for pindolol as an antidepressant

Posted by SLS on March 2, 2001, at 22:29:18

In reply to The case for pindolol as an antidepressant , posted by SalArmy4me on March 2, 2001, at 8:58:33

Dear SalArmy4me,

Thanks again for the reminder.

> This treatment for depression is nothing new, actually. Pindolol is a beta-blocker, the only one of its class known to speed up the action of antidepressants.

Although pindolol does block NE beta receptors, it also does other things. The one thing that is perhaps most focused on currently is the ability of pindolol to block the serotonin 5-HT1a autoreceptor. Antagonizing this receptor has the effect on increasing serotonin activity. I guess the idea is that the different pro-serotonergic effects of pindolol and the SSRIs act together to produce more pronounced changes in serotonergic neurotransmission.

I will eventually get a better impression of the utility of pindolol clinically, as my doctor is an assistant professor at NYU.

> I promote pindolol because it once made the most dramatic difference in my life.

God bless.

> I took 10 mg per day in two divided doses.

> Drawbacks:

> 1) It MUST be taken in brand form--not generic.

> 2) It can cause stomach-upset. This can be remedied with famotidine, cimetidine, or protonix.

> 3) It takes as long as antidepressants to work, and

> 4) it cannot be used in the place of a regular antidepressant/anticonvulsant.

> But these drawbacks never convinced me to stop using it.

One of the more interesting strategies that AndrewB found is to combine pindolol and buspirone together with antidepressants. The rationale of the investigators was that antagonizing somato-dendritic 5-HT1a autoreceptors (pindolol) and agonizing postsynaptic 5-HT1a receptors (buspirone) would produce a synergy. The results of the study demonstrated that each drug enhanced antidepressant response to SSRIs, but the combination of the two was significantly more effective than either alone.


Wishing you continued health...


Sincerely,
Scott

 

Re: posting something from time to time

Posted by Dr. Bob on March 2, 2001, at 23:06:31

In reply to The case for pindolol as an antidepressant , posted by SalArmy4me on March 2, 2001, at 8:58:33

> I post this from time to time because some people haven't even heard of certain treatment options...

It's great that you're trying to help people out, but there's such a thing as information overload, too, so please in the future do not start a thread with something you've posted before.

OTOH, if there's an ongoing discussion in which a certain treatment option's being left out, please feel free to bring it up. But even then, it's more efficient just to post the URL of a previous post than to repost the whole message. Thanks,

Bob

PS: Follow-ups, if any, regarding this should be redirected to Psycho-Babble Administration.

 

Re: The case for pindolol as an antidepressant

Posted by NikkiT2 on March 3, 2001, at 10:33:02

In reply to Re: The case for pindolol as an antidepressant , posted by SLS on March 2, 2001, at 22:29:18

If this is a beta blocker it can be dangerous remember, other than the drawbacks you mentioned. I suffer low blood oressure, and a beta blocker can lower blood pressure. When Iw as prescribed one once it made me really ill and I had dangerouslky low blood pressure.

 

Re: The case for pindolol as an antidepressant

Posted by JahL on March 3, 2001, at 11:01:02

In reply to Re: The case for pindolol as an antidepressant , posted by NikkiT2 on March 3, 2001, at 10:33:02

> If this is a beta blocker it can be dangerous remember, other than the drawbacks you mentioned. I suffer low blood oressure, and a beta blocker can lower blood pressure. When Iw as prescribed one once it made me really ill and I had dangerouslky low blood pressure.

Right. Beta-blockers have also been implicated in the exacerbation of depression (& so are perhapos not quite as benign as they appear).

J

 

Re: The case for pindolol as an antidepressant

Posted by JohnL on March 4, 2001, at 3:52:51

In reply to The case for pindolol as an antidepressant , posted by SalArmy4me on March 2, 2001, at 8:58:33

> I post this from time to time because some people haven't even heard of certain treatment options--so they try other augmentation agents that have less evidence behind them, and work poorly or not at all. Examples of these unproven agents include Omega3s, amantadine, inositol, or all the over-the-counter vitamins, minerals, or herbs--save hypericum.
>
> No augmentation agent will work as well as Lithium. This is the first choice in augmentation according to my doctor and the Harvard Psychiatry Depression Algorithym (http://mhc.com/Algorithms/Depression/). But if you cannot take the side-effects of Lithium, do not have a thyroid deficiency (which exacerbates depression), or have not done well on buspirone, Harvard mentions Visken (rx only: pindolol)--also featured prominently on the New York University Psychiatry website: http://www.med.nyu.edu/Psych/aug/index.html
>
> This treatment for depression is nothing new, actually. Pindolol is a beta-blocker, the only one of its class known to speed up the action of
> antidepressants. The main studies done (found on Medline) have used it most effectively with sertraline, although it has been tried and
> proven effective with most of the SSRIs, tranylcypromine and moclobemide, and a few of the tricyclics. See Dr. Bob's
> Psychopharmacology website (uhs.bsd.uchicago.edu/~bhsiung/tips/tips.html) and look up pindolol for more information.
>
> I promote pindolol because it once made the most dramatic difference in my life. I took 10 mg per day in two divided doses. Drawbacks: 1) It MUST be taken in brand form--not generic. 2) It can cause
> stomach-upset. This can be remedied with famotidine, cimetidine, or protonix. 3) It takes as long as antidepressants to work, and 4) it cannot be used in the place of a regular antidepressant/anticonvulsant.
> But these drawbacks never convinced me to stop using it.
>
> Best wishes for your full recovery by Easter...

My psychiatrist has tried Pindolol over the years and had no success with anyone.

 

Re: The case for pindolol as an antidepressant

Posted by JahL on March 4, 2001, at 13:22:44

In reply to Re: The case for pindolol as an antidepressant , posted by JohnL on March 4, 2001, at 3:52:51


> > My psychiatrist has tried Pindolol over the years and had no success with anyone.

I think the fact that most of the studies were mid-late 90's, and that clinical interest has since petered out, perhaps tells us something.

J

 

Re: The case for pindolol as an antidepressant

Posted by SalArmy4me on March 4, 2001, at 18:09:24

In reply to Re: The case for pindolol as an antidepressant , posted by JahL on March 4, 2001, at 13:22:44

People have been using the generic pindolol as opposed to the brand name Visken. Thus, their chance of success is lowered...I'm going to have to find that conclusion in the Tips for you.

>
> > > My psychiatrist has tried Pindolol over the years and had no success with anyone.
>
> I think the fact that most of the studies were mid-late 90's, and that clinical interest has since petered out, perhaps tells us something.
>
> J

 

Re: The case for pindolol as an antidepressant

Posted by SLS on March 5, 2001, at 8:57:49

In reply to Re: The case for pindolol as an antidepressant , posted by JahL on March 4, 2001, at 13:22:44

>
> > > My psychiatrist has tried Pindolol over the years and had no success with anyone.
>
> I think the fact that most of the studies were mid-late 90's, and that clinical interest has since petered out, perhaps tells us something.
>
> J


Maybe. But I have read people on Psycho-Babble describe pindolol as being their savior adjunctive medication. One person tested its efficacy by removing it, only to relapse. Fortunately he was able to recover an antidepressant response upon its reintroduction.

Perhaps this tells us something about clinical studies. Pindolol might be a low-percentage treatment, but I am keeping it on my list.


- Scott

 

Re: The case for pindolol as an antidepressant ยป SLS

Posted by JahL on March 5, 2001, at 9:43:30

In reply to Re: The case for pindolol as an antidepressant , posted by SLS on March 5, 2001, at 8:57:49

> >
> > > > My psychiatrist has tried Pindolol over the years and had no success with anyone.
> >
> > I think the fact that most of the studies were mid-late 90's, and that clinical interest has since petered out, perhaps tells us something.
> >
> > J
>
>
> Maybe. But I have read people on Psycho-Babble describe pindolol as being their savior adjunctive medication. One person tested its efficacy by removing it, only to relapse. Fortunately he was able to recover an antidepressant response upon its reintroduction.
>
> Perhaps this tells us something about clinical studies. Pindolol might be a low-percentage treatment, but I am keeping it on my list.
>
>
> - Scott

Yeah. Not much thought went into my last post. In fairness to Sal the available literature does suggest, quite convincingly, that Pindolol may significantly shorten the latency of onset of anti-depressive action when combined with SSRIs & possibly other ADs. Also the dosing schedule used in most studies (2.5mg t.i.d) is thought by some 2 be too low.

The evidence that Pindolol synergistically (as opposed to additively) augments ADs *beyond* the onset period is less convincing, tho' I'll keep an open mind. I, like you, put more faith in patient reports than yr average pdoc.

Jah.


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