Faster onset of action of fluvoxamine in combination with pindolol in the treatment of delusional depression: A controlled study

This double-blind controlled study was undertaken to investigate whether th e addition of pindolol could improve the therapeutic response to fluvoxamin e of depressed patients with psychotic features. After a 1-week placebo run -in period, 72 patients received fluvoxamine 300 mg/day in combination with placebo or pindolol 7.5 mg/day. At study completion, 28 (80%) of 35 patien ts treated with fluvoxamine plus placebo and 29 (80.5%) of 36 patients trea ted with fluvoxamine plus pindolol were categorized as responders (reductio n of their score on the al-item Hamilton Rating Scale for Depression to 8 o r less and on the Dimension for the Delusional Experience Rating Scale to 0 ). In the third and fourth weeks, the response rates were significantly sup erior in the fluvoxamine plus pindolol group (p = 0.0001, p 0.023, respecti vely). Treatment response seemed to be unrelated to the demographic and the clinical characteristics recorded. No significant difference was found comparing plasma levels of fluvoxamine between groups, thus excluding a pharmacokinetic interaction. Other than mi ld nausea and sedation in a few patients, treatments mere well tolerated. N o medically significant adverse events occurred. Depressed patients with ps ychotic features who were administered pindolol experienced a more rapid im provement during fluvoxamine treatment. Thus, the combination of fluvoxamin e with pindolol may be a useful pharmacologic strategy in the treatment of this disorder. A rapid clinical response in such patients is of relevance i n clinical practice as well as in economic fields, given the direct and ind irect costs of depression.