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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Crotale on July 5, 2008, at 0:52:04
Hi. Some years back (when I was still in school) I did a paper on augmenting ADs with pindolol, a type 1a serotonergic autoreceptor antagonist (and beta blocker, but that's not the important part). At the time the evidence wasn't conclusive, but since then there has apparently been more research, some of which suggests that pindolol both accelerates the action of SRIs and augments their efficacy. Has anybody here tried this? (pindolol + SSRI, pindolol + mixed RI, etc.)? I don't think it would be effective with a SNRI (selective norepinephrine RI), and I suspect it would be dangerous with an MAOI. (autoreceptor antagonists cause the NT to be released extracellularly; that's why alpha-NE autoreceptor agonists, like clonidine and guanfacine, are used for treating ADHD; they're also used to treat opioid withdrawal symptoms in drug addicts.
Posted by Racer on July 5, 2008, at 15:44:59
In reply to anyone have experience with pindolol augmentation?, posted by Crotale on July 5, 2008, at 0:52:04
I wasn't on an SSRI at the time, and the pindolol had some side effects I just don't tolerate well. Therefore, I didn't stay on it long, so I can't tell if it might have been effective in the long run.
This is a tangent:
One of the things that really leaves me feeling deflated about the whole MedicationGoRound is how often I've tried a medication, only to go off it after a short time due to side effects which, at the time, seemed intolerable. Later, looking back, I wonder if I should have tried to stick it out longer to see if the medication might have worked.
It's not an easy question for me, because often the "side effects" in question include sitting in one place, crying, and considering whether it's worth trying to continue living. I know that medications take a while to show their stuff, and I do try to stick it out as long as possible, but I'm often left looking back and wondering, "If we'd added this to try to mitigate the side effects..." or "maybe it won't be as bad as it was before..."
Bah. I hate second guessing myself.
The pindolol didn't last long for me. But my psychopharmacologist is pretty brilliant, and he thought it was a good idea, so my guess is that it's got some promise.
Posted by bleauberry on July 5, 2008, at 20:58:11
In reply to For a short time... » Crotale, posted by Racer on July 5, 2008, at 15:44:59
On topic...I tried pindolol for about a week with prozac. I felt a sense of improvement on day three where trees seemed greener and my toothbrush looked more purple. It was over a decade ago and we actually had a thread here about green grass and purple toothbrushes! :) Off topic...how I could remember that after ECT, and yet other things are totally wiped out, I have no idea. Back on topic...I could not withstand the dizziness, tiredness, and loss of blood pressure. I could barely even walk from my car across a parking lot, not to mention actually work, which is what I had to do to feed my family and pay a mortgage. So pindolol went bye bye.
Off topic to Racer...
Yeah, I second guess myself all the time. Enough times that I've even gone back to try a lousy med three or four more times, always thinking it would be different this time, I would be stronger and more determined this time. Not. It never works. The side effects you endured the first time are usually the same or worse. And you don't fully remember or recall how devastating they were until you actually swallow that pill and feel them again.I know we differ on this, and I respect that entirely, but when someone is on their knees sobbing after starting a new medication, that is not a side effect. That is called, in clinical terms, deterioration. People rarely go from that to feeling better. It is not a matter of waiting for it to kick in, because it aint gonna do that. It's already kicked in, in the wrong way. It aint gonna turn around into some miracle. If it starts real bad, it will probably not have a good outcome. Clinical evidence supports that. Studies have been done looking specifically at that. Basically it goes like this...early improvement indicates higher likelihood of response...no early improvement indicates possible response, but delayed longer...early deterioration indicates likelihood of zero response or further deterioration, patient feels better when it is stopped.
I hate second guessin myself too. Gets me into trouble over and over. I'm moving ahead into new ground. There are plenty of other causes of psychiatric illnesses besides the overly simplistic flawed unproven theories of deficient neurotransmitters. I mean, if that was so true, Tianeptine would never work for anyone. The fact that is works on neuroplasticity, nerve growth factor, gene communication, HPA axis regulation, dendrite growth, and other unique stuff, well, let's put our second guessing behind us and look forward to a new direction. We've played the reuptake inhibition game more than anyone should ever have to bear, including my worst enemy.
>
> Bah. I hate second guessing myself.
>
Posted by JohnnyBLinux on July 12, 2008, at 3:49:07
In reply to anyone have experience with pindolol augmentation?, posted by Crotale on July 5, 2008, at 0:52:04
Hi Crotale, I'm prescribed both pindolol 5mg 2x/day and Lexapro 10mg. Lexapro was added about a month ago. I started taking pindolol about a year ago. The combination is safe. I replied to this post b/c I just read a webpage about augmenting antidepressant therapy w/ pindolol. You can read more on this particular subject here:
Posted by JohnnyBLinux on July 12, 2008, at 4:12:06
In reply to anyone have experience with pindolol augmentation?, posted by Crotale on July 5, 2008, at 0:52:04
I forgot to add that since pindolol came first, I don't *really* have experience w/ augmentation, sorry.
The proper order of things would be first the SSRI, then pindolol augmentation.
Posted by Crotale on July 15, 2008, at 13:17:27
In reply to Re: anyone have experience with pindolol augmentation?, posted by JohnnyBLinux on July 12, 2008, at 3:49:07
Thanks for the URL. I'd say that the combination counts as augmentation even if you started the pindolol first (what were you taking it for?). Did you find the pindolol accelerated or otherwise enhanced the Lexapro? (Well, I guess you couldn't say for sure about augmentation since you weren't taking the Lexapro by itself before, but did it start working faster than you would have expected?)
BTW I know the combo pindolol+SSRI is safe. The one I question is pindolol+MAOI.
-Crotale
Posted by JohnnyBLinux on July 16, 2008, at 0:56:14
In reply to Re: anyone have experience with pindolol augmentat » JohnnyBLinux, posted by Crotale on July 15, 2008, at 13:17:27
I take pindolol for high blood pressure. I would say that the combination of Lexapro + pindolol has not resulted in an enhancement of Lexapro. Again, it's hard to say because I didn't start with Lexapro.
As far as pindolol + an MAOI, here's what I found using the drug interaction checker at http://www.drugs.com/ :
pindolol and Nardil (phenelzine) (Minor Drug-Drug)
Monoamine oxidase inhibitors (MAOIs) may theoretically potentiate the hypotensive effect of some medications. This effect may stem from a gradual MAOI-induced accumulation of false neurotransmitters in peripheral adrenergic neurons that have minimal activity at alpha- and beta-adrenergic receptors, resulting in a functional block of sympathetic neurotransmission. Indeed, MAOIs alone quite commonly produce orthostatic hypotension. In addition, bradycardia has been reported with the concomitant use of beta blockers and MAOIs. The clinical significance of these effects is unknown. If these drugs are coadministered, patients should be monitored for evidence of an interaction (e.g., hypotension, orthostasis, bradycardia, tachycardia, dizziness, or syncope).I selected Nardil at random. It seems we have a number of Babblers on this medication. Hope this helps!
Posted by christophrejmc on July 16, 2008, at 8:25:39
In reply to anyone have experience with pindolol augmentation?, posted by Crotale on July 5, 2008, at 0:52:04
I tried pindolol+buspirone several years ago. I probably got the idea from this article: http://www.biopsychiatry.com/buspfast.htm, although I think Stahl also wrote about it in one of his psychopharm books. I had been on BuSpar before, so I wasn't really expecting anything, but it did seem to have some effect that couldn't be explained by the BuSpar alone (or perhaps it was just a placebo effect).
If I ever try another SSRI again (which is unlikely), I will try adding pindolol--I think it definitely has some utility in hastening the antidepressant effect, if nothing else.
-chris
Posted by Crotale on July 27, 2008, at 14:41:57
In reply to For a short time... » Crotale, posted by Racer on July 5, 2008, at 15:44:59
Racer,
I think I have at least some idea how you feel.
I've been frustrated lately by what I know are really quite mild cognitive side fx from ECT: mild word-finding difficulty (anomia). ECT doc insists I ask my regular pdoc (who I don't see until mid-August sometime) about medications to control or prevent such side effects.
I've had problems quitting medications because of the side effects too. And sometimes wondering, if I were feeling better, could I have gotten this under control? (e.g. constipation by high-fiber diet - which of course would require eating at all) Or could I have convinced pdoc to help me with the side effects somehow (like prescribing something for nausea/vomiting), if I'd had more self-confidence? Or would I have been simply more determined not to give up?
-Crotale
P.S. I think I mentioned the main reason I was curious about pindolol was because I wrote a paper about it as an antidepressant-augmentor (and in particular, -accelerator) something like 9 or 10 years ago. My guess is it has at least some promise if they're still messing with it after all that time.
Posted by Crotale on July 27, 2008, at 22:16:29
In reply to Re: anyone have experience with pindolol augmentat » Crotale, posted by JohnnyBLinux on July 16, 2008, at 0:56:14
> I take pindolol for high blood pressure. I would say that the combination of Lexapro + pindolol has not resulted in an enhancement of Lexapro. Again, it's hard to say because I didn't start with Lexapro.
Well, it's not necessarily supposed to enhance them so much as make them start working faster ("acceleration" would have been more accurate than "augmentation," really). Which would be pretty cool, if it actually works. In my experience one of the most difficult things about ADs is that it takes so long to find out if they work. Even if they do, not having any response for several weeks is, well, painful. And having to wait six weeks just to find out that an AD *doesn't* work, well, that's pretty frustrating.
In response to the quote from drugs.com...that's just a possible interaction between MAOIs and beta blockers in general. I've found propranolol fine with MAOIs (although beta blockers may not be the best choice for lowering blood pressure in the case of MAOI-sympathomimetic interactions because beta blockers are actually vasoconstrictors).
I was curious about the possibility of serotonin syndrome as a result of pindolol's blockade of serotonergic autoreceptors. Your drugs.com monograph doesn't mention that issue.
(I doubt any drug monograph will discuss this special quirk of pindolol. I was hoping we might have some brave/crazy person here like Scott -- no offense Scott, you impress me, it's just that I'm still in a state of disbelief & shock over your daring to combine a nonselective irreversible MAOI with imipramine without actual suicidal intentions...err, at least I assume you didn't have suicidal intentions -- who had tried it.)
This is the end of the thread.
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