FAST ONSET - AN OPEN STUDY OF THE TREATMENT OF MAJOR DEPRESSIVE DISORDER WITH NEFAZODONE AND PINDOLOL COMBINATION THERAPY

Pindolol. a beta-adrenergic and presynaptic 5-HT1A antagonist, when ad ded to specific serotonin reuptake inhibitors, potentiates the antidep ressant action, leading to an earlier onset of effect. Following on fr om the suggestion that nefazodone, a specific serotonin reuptake inhib itor and antagonist of 5-HT2, improves 5-HT1A-mediated transmission, w e used a pindolol and nefazodone combination treatment for major depre ssive disorder. Twenty outpatients underwent a 4-week trial. Patients were seen twice a week and completed efficacy and safety measures incl uding the 17-item Hamilton Depression Scale, the Montgomery-Asberg Dep ression Rating Scale and the Clinical Global Impression scales. Result s demonstrated significant improvement in all efficacy measures after one visit (2-4 days of treatment), with decreasing depression scores o n all measures continuing throughout the trial. After 1 week of treatm ent, 15 out of 20 patients had experienced a 50% or greater reduction in their 17-item Hamilton Depression Scale scores. Remission rates wer e dramatic, with 40% of patients in remission after 1 week of treatmen t and 90% after 1 weeks. This open study of nefazodone-pindolol combin ation therapy suggests that this may be a new treatment option for pat ients with major depressive disorder; however, it needs to be replicat ed in a double-blind trial before conclusions regarding efficacy and s afety can be made.