8; r: 80  10 [%]) and REM time (b: 93.06  27.72; r: 46.25  16.98 [min]). No significant changes were observed in spectral analysis. In conclu- sion the noradrenalin reuptake inhibitor reboxetin showed similar effects like SSRI’s on sleep eeg. 266. TREATMENT WITH THE PRESYNAPTIC 5-HT 1A -ANTAGONIST PINDOLOL IN PATIENTS WITH PANIC DISORDER M. Ziegenbein, A. Steiger and H. Murck Max Planck Institute of Psychiatry, 80804 Munich, Germany SSRIs like paroxetine play an important role in the treatment of patients with panic disorder. It is striking to observe that at the beginning of the treatment an exacerbation of the symptoms occurs, usually in the form of an increase in the number of spontaneous attacks. It is known that at the beginning of the treatment with SSRIs the activity of serotonergic neurons in the nucleus raphe dorsalis (DRN) is suppressed via 5-HT 1A autoreceptors, therefore inhibiting serotonin (5HT) tone in projection areas (Romero et al., 1996). As locus coeruleus (LC) neurons are suppressed by 5-HT from the DRN and their activation accompanies anxiety, the increase in anxiety in panic disorder could be mediated via the inhibition of DRN-neurons. We therefore studied the effect of the presynaptic 5-HT 1A /-adrenergic antagonist pindolol on the clinical response in 3 inpatients (2 male, 1 female) with spontaneous panic attacks. All were diagnosed as suffering from panic disorder according to the DSM-IV criteria. It was ensured that these patients did not have a history of asthma or low blood pressure. We gave pindolol, 2.5mg three times daily in combination with an SSRI (10 mg paroxetine or citalopram at the beginning). The patients took the pindolol and SSRI regimen without reporting untoward side effects. An increase of spontaneous panic attacks was not found. All patients had a marked improvement of panic symptoms and remitted quickly. Our results indicate that pindolol addition to SSRIs is highly effective in reducing panic symptomatology. 267. rTMS TREATMENT OF PTSD AND MAJOR DEPRESSION P.B. Rosenberg, M. Balish Department of Veterans Affairs Medical Center, Washington, DC Repetitive transcranial magnetic stimulation (rTMS) is a new modality with potential for treating mood disorders. Antidepressant treatment of depressive and post-trauma symptoms in post-traumatic stress disorder (PTSD) gives mixed results, and in clinical practice there are many non-responders. We administered rTMS as an open-label adjunctive treatment to antidepressant medication to 7 patients with PTSD and major depression diagnosed on Structured Clinical Interview for diagnosis. rTMS was administered at 90% of motor threshold at either 1 Hz or 5 Hz daily for 10 days. 40 stimuli/minute were administered for 15 minutes daily, for a total of 6000 stimuli per patient. Outcome measures included Hamilton Depression Rating Scale (HAM-D), Mississippi Scale of Combat Sever- ity, Profile of Mood States (POMS), and University of Southern California Repeatable Episodic Memory Test (USC-REMT). Statistical significance was assessed with repeated-measures ANOVA. All 7 patients tolerated rTMS well with no EEG changes or side effects except transient headache. Mean HAM-D scores decreased from 27.9 to 13.6 two months after rTMS (p = .000) while sleep scores trended toward improvement. POMS subscales Tension-Anxiety, Depression- Dejection, Anger-Hostility, and Vigor-Activity showed significant im- provement (p  05). Mississippi score decreased from 124 to 111 two months following rTMS (p  .05). USC-REMT scores were unchanged. Depressive symptoms improved robustly after rTMS treatment in an open-label study of 7 patients with PTSD and major depression, while sleep and trauma symptoms decreased to a lesser extent. rTMS may be a promising new treatment for depression in PTSD. 268. SIMULTANEOUS CATECHOLAMINE AND INDOLEAMINE DEPLETION IN UNMEDICATED DEPRESSED SUBJECTS R.M. Berman, G. Sanacora, M. Narasimhan, D.A. Oren, A. Cappiello, D.S. Charney Yale University School of Medicine; Connecticut Mental Health Center, New Haven, CT 06519; and West Haven VA Medical Center, West Haven, CT 06516 Although significant evidence suggests that alterations in monoamine systems are associated with clinical depression, catecholamine or indole- amine depletion alone has not been associated with significant mood changes in unmedicated depressed subjects, a finding that complicates the classic monoamine hypotheses on the neurobiology of depression. As one possible explanation, dysfunction in one monamine system may be balanced by intact function in another. To test this hypothesis, unmedicated depressed subjects underwent a 2-week, double-blind, random-ordered crossover study consisting of the following active and control conditions respectively: indoleamine (via tryptophan depletion) plus catecholamine (via alpha- methyl-paratyrosine administration) depletion and, separately, indoleamine plus sham (via diphenhydramine administration) depletion and, separately, indoleamine plus sham (via diphenhydramine administration) catecholamine depletion. Ten subjects completed both conditions; 2 subjects were with- drawn after active testing and one after control testing. Time (F 7.1, df 4, 36, p = 0.0003) but not time-by-condition or condition effects were statistically significant. Mean HDRS scores decreased progressively throughout the study days (baseline 26.7 points  1.4 SEM; termination 21.3  1.7). Response (i.e., 50% HDRS decrease and maximum score 15 points) rates were 3 [25%] of 12 subjects undergoing active testing and 4 [36%] of 11 undergoing control testing, inclusive of follow-up day ratings. Overall, results suggest that simultaneous disruptions of indoleamine and catechol- amine function do not exacerbate symptoms in unmedicated depressed subjects, thus lending further support to the notion that monoamines regulate mood in actively depressed patients via indirect mechanisms. 269. CHANGES IN ANXIETY AFTER PREFRONTAL rTMS IN PATIENTS WITH GAD J.P. Lorberbaum (1,2), N.P. Emmanuel (1), O. Mintzer (1), R. Kapp (1), M. Crawford (1), A. Morton (1), M.R. Johnson (1,2), S.W. Book (1), M.B. Hamner (1,2), Z. Nahas (1), G.W. Arana (1,2), J.C. Ballenger (1), R.B. Lydiard (1), M.S. George (1,2) (1) Medical University of South Carolina, Charleston, SC 29425; (2) Ralph H. Johnson VA Medical Center, Charleston, SC 29425 While prefrontal repetitive Transcranial Magnetic Stimulation (rTMS) is being widely investigated for treating depression, the use of rTMS in anxiety disorders has not been extensively studied and use in Generalized Friday Abstracts 81S BIOL PSYCHIATRY 2000;47:1S–173S