Rapid cycling triggered by pindolol augmentation of paroxetine, but not with desipramine

A treatment-resistant depressed patient developed bipolar rapid cycling in response to pindolol augmentation of paroxetine, after failing to respond in any fashion to pindolol added to desipramine. The rapid cycling initially faded, but recurred after the pindolol dose was increased (in combination with paroxetine) in an attempt to treat a relapse into depression. Her differential development of rapid cycling with pindolol in combination with the SSRI is in keeping with the theory that pindolol augmentation operates via a serotonergic mechanism. Depression 4:92–94 (1996). © 1997 Wiley-Liss, Inc.