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Biochemical Effects of Antidepressant Augmentation

Robert H. Howland, MD
Arch Gen Psychiatry. 1995;52(2):156. doi:10.1001/archpsyc.1995.03950140074012.
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In their report on the use of pindolol to augment selective serotonin (5-HT) reuptake inhibitors and monoamine oxidase inhibitors, Artigas et al1 suggest that this may be mediated by presynaptic 5-HTIA antagonism, resulting in enhanced serotonergic function. Buspirone, a 5-HTIA agonist, also may be effective in augmenting selective 5-HT reuptake inhibitors in refractory depression.2-5 Because pindolol and buspirone have opposite effects on 5-HTIA function, their efficacy is therefore difficult to reconcile on this basis. Furthermore, it is not clear how 5-HTIA antagonism could account for the effect of pindolol, because reduced sensitivity of presynaptic 5-HTIA receptors is found in major depression.6,7

A major metabolite of buspirone is the α2-adrenergicantagonist 1-(2-pyrimidinyl)-piperazine.8,9α2-Adrenergic antagonism by 1-(2-pyrimidinyl)-piperazine could enhance the release of norepinephrine and result in mood elevation,10 which is consistent with the mechanism of antidepressants such as mianserin11

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