Pindolol (Visken)
Antihypertensive (beta-blocker, speeds up SSRIs by blocking blocking 5-HT1A autoreceptors, increasing serotonin release, but only when started with an SSRI)
Mechanism
- Major Depression [3]
- OCD [3]
- Panic [3]
Features
Dosing
Depression: start 5 mg bid x7days then 5 mg tid or 10 mg bid. Only use in depression when starting SSRIs to accelerate response. Taper off over 2 weeks after a 4-8 week course.
Panic disorder and OCD: 2.5 mg tid.
Management
Pindolol accelerates but does not improve antidepressant response, so short-term use is ideal.
Although there are trials in bipolar depression (2.5 mg tid) and child ADHD (20 mg bid), these have problems. The ADHD trial had no placebo control. In the bipolar trial, it augmented sleep deprivation, but it can also trigger mania and psychosis in bipolar.
TOLERABILITY: hypotension, dizzy, fatigue (dose-dependent). Rare irritability.
RISKS: Avoid in cardiac disease.
EMR Text
Depression
Pindolol use based on randomized controlled trials where it accelerated antidepressant response (Liu Y et al, Hum Psychopharmacol 2015, 30(3):132-142; Portella MJ et al, J Clin Psychiatry 2011;72(7):962-969).
Pindolol side effects, including cardiac, reviewed with patient.
OCD
Pindolol use based a small controlled trial where it augmented treatment for OCD (Sassano-Higgins SA and Pato MT, J Pharmacol Pharmacother. 2015;6(1):36-8).
Pindolol side effects, including cardiac, reviewed with patient.
Panic
Pindolol use based a small controlled trial where it augmented treatment for panic disorder (Hirschmann S et al, J Clin Psychopharmacol 2000;20(5):556-559).
Pindolol side effects, including cardiac, reviewed with patient.