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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 linkadge on December 7, 2006, at 21:06:18
I keep reading about pindolol on augmentation strategy websites. Over, and over, yet *nobody* uses this drug. Whats up?
Linkadge
Posted by Quintal on December 7, 2006, at 21:17:07
In reply to Pindolol: talked about, never used., posted by linkadge on December 7, 2006, at 21:06:18
I'm not sure. I've used it myself though and it seemed to make me feel more anxious and panicky. I wonder if this is something to do with its serotogenic effects? Maybe I should have stuck it out longer?
There's a packet lying around in my old meds chest somewhere. I might just give it another go if some convincing evidence comes to light on this thread.
Q
Posted by psychobot5000 on December 7, 2006, at 22:07:30
In reply to Re: Pindolol: talked about, never used. » linkadge, posted by Quintal on December 7, 2006, at 21:17:07
I mentioned it to one doc, and she'd never heard of it.
I looked over the data, and it clearly indicated a speeding of the respones to paxil and probably fluoxetine (but NOT sertraline), but in the more sensitive studies the positive effect gradually disappeared after week 2. The theory seemed to be that, as an autoreceptor antagonist, it blocked the feedback loop, preventing all the extra serotonin from triggering diminished release, and thus allowing the levels to stay higher at the beginning of treatment, and increasing efficacy. However, as the non-pindolol pts' autoreceptors were desensitized, the effect disappeared.
The evidence that it only seems to be useful in speeding AD response, as opposed to potentiating it, along with the CW that beta-blockers may be depressogenic, seems to effectively keep practicioners from being enthusiastic about it. That's my guess. Also, isn't it old and off-patent, meaning no one makes much off of it?
Posted by linkadge on December 8, 2006, at 8:45:15
In reply to Re: Pindolol: talked about, never used., posted by psychobot5000 on December 7, 2006, at 22:07:30
I think there is more convincing evidence that there is dysfunction of serotonin autoreceptors than there is of altered uptake or MAO function.
ECT for instance alters autoreceptor function without affecting serotonin uptake etc. As supposedly does rTMS.ALso, I remember reading that some uptake inhibitors paxil, fluoxetine, but others citalopram, sertraline led to a downregulation of autoreceptors.
Some new drugs are serotonin 1a/1b autoreceptor antagonists. Supersensitivity of both 1a and 1b autoreceptors exist in depression, and the two controll serotonin release in discrete brain regions.
I have always wondered what a combination of lithium and pindolol would do. Lithium is a 5-ht1b autoreceptor antagonist and pindolol a 5-ht1a autoreceptor antagonist.
Linkadge
Posted by Jimmyboy on December 8, 2006, at 8:59:41
In reply to Re: Pindolol: talked about, never used., posted by linkadge on December 8, 2006, at 8:45:15
There are some studies about a really good response to Sezone + Pindolol and its even got a snazzy nickname like the something "cocktail" .
Posted by sdb on December 8, 2006, at 10:32:24
In reply to Pindolol: talked about, never used., posted by linkadge on December 7, 2006, at 21:06:18
> I keep reading about pindolol on augmentation strategy websites. Over, and over, yet *nobody* uses this drug. Whats up?
>
>
> LinkadgeI can only give an answer from the standpoint of cardiology.
Pindolol is an unselective betablocker with the highest affinity for beta-receptors. It can even cause heart pain because of constriction of the coronary arteries. Because Pindolol has ISA, with longer use there will be a beta-downregulation and following vasodilation of the blood vessels.
That drug is not that harmless for some individuals.
There is another one: Bopindolol which is a prodrug active itself and two active metabolites. It's the betablocker with the strongest affinity to the receptor even changing the receptor maybe through allosteric mechanisms, thus effect works some days continuously even after complete eliminaton of the substance in the compartments of the body.
Bopindolol is much more used now due to its long-lasting effect, different pharmacokinetics and antioxidative effects.
Bopindolol is not available in the US.
I don't know about Pindolol's effectiveness to augment AD's
sdb
ps. sorry can't post frequently, internet connection at home is disconnected (provider problem).
Posted by linkadge on December 8, 2006, at 10:37:21
In reply to Re: Pindolol: talked about, never used., posted by Jimmyboy on December 8, 2006, at 8:59:41
Yeah, the "Dalhaouse serotonin cocktail" or something. Wasn't it like pindolol, serzone, and tryptohpan?
Why not throw in lithium for good measure?
Linkadge
This is the end of the thread.
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