Pindolol augmentation enhances response outcomes in first depressive episodes

Effectiveness of Pindolol addition to SSRIs is still a matter of debate. Recently, Geretsegger et al. [Geretsegger, C., Bitterlich, W., Stelzig, R., Stuppaeck, C., Bondy, B. and Aichhorn, W. (2008) Paroxetine with Pindolol augmentation: a double-blind, randomized, placebo-controlled study in depressed in-patients. Eur. Neuropsychopharmacol. 18, 141–146.] have found that never-medicated depressed patients showed a significant sustained response with Paroxetine + Pindolol treatment. Also, patients with a first depressive episode displayed a trend for higher sustained response rates with Pindolol co-administration. Re-analysing the data of a previous clinical trial of Fluoxetine + Pindolol [Pérez, V., Gilaberte, I., Faries, D., Alvarez, E. and Artigas, F. (1997). Randomised, double-blind, placebo-controlled trial of Pindolol in combination with Fluoxetine antidepressant treatment. Lancet 349, 1594–1597.], we have found that first depressive episodes are associated with a significant higher percentage of sustained responses when administering Fluoxetine + Pindolol (70.3%) compared to Fluoxetine + Placebo (44%). Moreover, based on a survival analysis, among the patients with a first depressive episode, those who received Fluoxetine + Pindolol achieved a sustained response significantly earlier (19 days) than those on Fluoxetine + Placebo (35 days). Interestingly, none of these effects were observed in the subsample of recurrent patients. The results suggest that Pindolol augmentation accelerates and enhances the action of SSRI at the beginning of the illness.