Elsevier

Heart Failure Clinics

Volume 7, Issue 1, January 2011, Pages 89-99
Heart Failure Clinics

A Review on the Putative Association Between Beta-Blockers and Depression

https://doi.org/10.1016/j.hfc.2010.08.006Get rights and content

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Initial signs of possible depressogenic properties

The discussion on β-blockers and depression started as early as 1967, when Waal20 reported a conspicuously high incidence of depression among a group of hypertensive patients using propranolol as an antiarrhythmic therapy. Subsequently, several case reports appeared in the literature describing patients with depressive symptoms after the use of the highly lipophilic propranolol.21, 22, 23, 24, 25 Also some other β-blockers were described in case reports to have a depressogenic effect, such as

Presumed underlying mechanisms

The exact mechanisms underlying these central nervous system (CNS) adverse effects are still speculated about, but commonly, 4 general mechanisms that were extensively described by Koella33 are referred to:

  • 1.

    A centrally mediated specific β-adrenergic mechanism: β-blockers that penetrate the brain in sufficiently high amounts (especially the lipophilic ones) bind to adrenergic receptors. By blocking the adrenergic receptors, they suppress information flow in noradrenergic β-receptor–mediated

Systematic studies on β-blockers and depression

Following the case reports, many investigators tried to verify the putative association between β-blockers and depression in systematic studies. These studies can be categorized into 4 main categories, depending on their design (Table 2).38 (1) Studies linking β-blocker use to antidepressant prescriptions; (2) randomized controlled trials (RCTs) on the efficacy of β-blockers in various patient categories, in which side effects, including depression, have been recorded; (3) studies on β-blocker

Discussion

Looking back on about 40 years of literature on β-blockers and depression, the discussion started with an impressive amount of case reports strongly suggesting a relationship between the use of a β-blocker and the development of depression in the individual patients described. More systematic studies that have been conducted subsequently did not in general find an increase in the rates of depression. Searching for reasons for the discrepancies between the case reports and the findings in the

Clinical implications

In patients with cardiovascular problems in general, including HF patients, one should not be reluctant to prescribe β-blockers out of fear of inducing a depression. It is not ruled out that-although based on weak scientific evidence-epecially, the highly lipohilic propranolol has a depressogenic effect. Also, patients with a positive personal or family history of depression might be at an increased risk. One should stay vigilant, and when there is a strong suspicion of β-blocker–induced

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    1

    From February 1, 2011: Department of Internal Medicine, University Medical Center Groningen, Huispost AA 41, PO Box 30.001, 9700 RB Groningen, The Netherlands.

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