Biochemical Effects of Antidepressant Augmentation

Robert H. Howland, MD

Arch Gen Psychiatry. 1995;52(2):156-156. doi:10.1001/archpsyc.1995.03950140074012

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ABSTRACT

ABSTRACT | REFERENCES

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-HT_IA 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-HT_IA function, their efficacy is therefore difficult to reconcile on this basis. Furthermore, it is not clear how 5-HT_IA antagonism could account for the effect of pindolol, because reduced sensitivity of presynaptic 5-HT_IA 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

REFERENCES

ABSTRACT | REFERENCES

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