![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by SalArmy4me on May 30, 2001, at 1:19:34
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.htmlThis 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 SSRI's, 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 Summer's end...
Posted by SLS on May 30, 2001, at 8:00:47
In reply to Pindolol Augmentation with Few Side-effects, posted by SalArmy4me on May 30, 2001, at 1:19:34
Hi Sal.
> 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.Pindolol has been labelled and pigeon-holed as a norepinephrine beta (receptor) blocker. However, it is an extremely potent antagonist at the serotonin 5-HT1a receptor as well. These are found predominantly as autoreceptors (somato-dendritic I think). As such, an antagonist of this receptor would increase the excitability of serotonergic neurons, thus facilitating serotonergic neurotransmission. Perhaps pindolol acts as a synergist with drugs known to act to increase the concentration of 5-HT in the synapse, i.e. SSRIs and MAO-inhibitors, the drugs you have listed as being most often augmented successfully with pindolol. I would like to know which of the tricyclics it has been shown to be effective with. Amitriptyline, clomipramine, doxepin?
Although I see that propanolol is also listed as an antagonist of 5-HT1a receptor, I can't find that it is used consistently as a biological probe for these receptors or compared against pindolol for potency at autoreceptor sites.
What are the current thoughts as to why pindolol might work?
Thanks for posting this review.
- Scott
Posted by SalArmy4me on May 30, 2001, at 9:58:02
In reply to Re: Pindolol Augmentation with Few Side-effects, posted by SLS on May 30, 2001, at 8:00:47
I don't really know the full truth behind its action, but I do know that it is strong enough to the point where I can use it as my primary antidepressant if I had to. It is very stimulating, too.
Posted by Cam W. on May 30, 2001, at 10:08:32
In reply to Pindolol Augmentation with Few Side-effects, posted by SalArmy4me on May 30, 2001, at 1:19:34
Sal - Why only brand name pindolol (Visken™ in Canada)? The generic versions must be between 95% and 105% bioequivalent to the brand name. The only difference being the tablet binders and excipients.
Also, here in Canada, we have what are called "ultra-generics", where the brand name company either starts their own generic company (eg. Altimed - Glaxo Wellcome/Upjohn/others; Linson - Bristol Meyers/Squibb) to compete against the strictly generic companies. Good scam, huh; sell both, but under different names and at different prices. The only difference is the dye stamp. Ya gotta shake your head.
Also, we have tried pindolol several times over the past few years to quicken SSRI response and to augment partial SSRI response. We have found that it really hasn't worked all that well in clinical practice; although, as Scott shows, it looks good on paper.
We've also never really had any problem with side effects, except for some dizziness and postural hypotension. One guy did report seriously smelly gas attacks (enough to drive his wife into the spare room). This was probably more due to diet (esp. the smell).
Thanks again, Sal - Cam
Posted by Elizabeth on May 30, 2001, at 14:49:53
In reply to Re: Pindolol Augmentation with Few Side-effects » SalArmy4me, posted by Cam W. on May 30, 2001, at 10:08:32
> Also, here in Canada, we have what are called "ultra-generics", where the brand name company either starts their own generic company (eg. Altimed - Glaxo Wellcome/Upjohn/others; Linson - Bristol Meyers/Squibb) to compete against the strictly generic companies.
Those exist in the U.S. too (brand-name drugs are even more expensive here than they are in Canada, you know!). The one that comes to mind is Greenstone, a generic maker of alprazolam tablets that look suspiciously identical to brand-name Xanax. < g > Greenstone is -- unsurprisingly -- a subsidiary of Pharmacia & Upjohn, makers of Xanax.
I have been taking Xanax for 5 years or so, and the only generic tablets I've ever gotten are the Greenstone ones. I wonder what effect the expiration of the patent on Xanax has had on P&U's profits...if any.
-elizabeth
Posted by stjames on May 31, 2001, at 0:40:15
In reply to Re: Pindolol Augmentation with Few Side-effects » SalArmy4me, posted by Cam W. on May 30, 2001, at 10:08:32
> Sal - Why only brand name pindolol (Visken™ in Canada)? The generic versions must be between 95% and 105% bioequivalent to the brand name. The only difference being the tablet binders and excipients.
James here.....
In this case there may be a difference in stereo isomers, Visken has both, generic just one.
James
Posted by JohnL on June 1, 2001, at 14:37:27
In reply to Re: Pindolol Augmentation with Few Side-effects, posted by SLS on May 30, 2001, at 8:00:47
I don't know about anyone else, but I had strong side effects from Pindolol. It was lousy.
My pdoc has tried Pindolol with a lot of patients and had not one single success story with it.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.