Posted by KaraS on November 10, 2004, at 15:04:51
In reply to Re: Nortriptyline + Pindolol?, posted by SLS on November 10, 2004, at 7:29:11
> > I know that Pindolol used to be used more to augment other meds in the past. I don't hear much about it these days. I'm not sure why. I was wondering if it could be used with nortriptyline or desipramine for the tachycardia and possibly provide some other good effects. I just read something about it being used with other classifications of meds but not the TCAs. Is there a good reason for that?
>
> Pindolol not only blocks NE beta receptors, but it also blocks 5-HT1a somato-dendritic serotonin autoreceptors. I guess the thinking is that this action would only be relevant when pindolol is combined with a primarily serotonergic drug. The only TCA considered primarily serotonergic is clomipramine (Anafranil). However, most other TCAs also inhibit the reuptake of 5-HT. Nortripyline is selective for NE compared to its parent compound, amitripyline, but still is moderately serotonergic.
>
> In recent years, and under increased scrutiny, pindolol augmentation has not shown itself to be effective to increase the number of responders to treatment of depression. Most of the current work remains focused on the possibility that pindolol hastens or accelerates the antidepressant response, but does not necessarily increase the percentage of people who respond to treatment. The number of investigations reporting positive results for a hastening of response are numerous and seem pursuasive.
>
> I was under the care of an associate professor at NYU when they still included pindolol in their algorithm to treat TRD. He discouraged me from trying it despite advocation on the part of the psychiatry department. I believe that pindolol remains on their algorithm. I would have to check.
>
> Should you trust the more recent opinions being offered by psychiatry? I don't know. You will still find many citations on Medline supporting the use of pindolol as an augmentor of SSRIs. Again, most of them focus on its purported ability to accelerate the response to antidepressants. At least one investigator claims that the dosages of pindolol used in most studies is too low, and would explain the lack of positive results when looking at the number of responders. Most studies use 7.5mg (2.5 t.i.d.).
>
> In other words, the efficacy of pindolol augmentation remains debatable. How should this affect your decision making process? Perhaps you should go on and try it, but keep your expectations low. You might be pleasantly surprised. If you are, I want to know about it.
>
> I haven't answered any of your questions very well. Sorry. I pretty much left you at the same point where you started. :-)
>
> The following two studies indicate that the number of responders to pindolol augmentation does not change. You'll find plenty of citations on Medline reporting the hastening effect, however. I guess I currently have a bias towards a limited usefulness of pindolol. However, I would hate to disuade you from trying a treatment that would be effective for you.
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15003079
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> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11199945
>
>
> - Scott
Scott,You definitely answered my questions. The decrease in its usage made me suspect its efficacy before I posted and, in fact, there doesn't seem to be much evidence to support it's use as a long-term augmentor. It does seem to have shown potential for hastening response time, though, which I would think is huge. I'm a little surprised that it isn't used more on a short-term basis for that purpose.
Thanks,
K
poster:KaraS
thread:414048
URL: http://www.dr-bob.org/babble/20041108/msgs/414308.html