A Review on the Putative Association Between Beta-Blockers and Depression
Section snippets
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:
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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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Initiation of β-blocker therapy and depression after acute myocardial infarction
2016, American Heart JournalInteractions of atenolol with alprazolam/escitalopram on anxiety, depression and oxidative stress
2014, Pharmacology Biochemistry and BehaviorCitation Excerpt :Given the fact that anxiety and depression are highly comorbid disorders, possibly sharing a common neurobiological mechanism, it would be interesting to evaluate the effects of β-blockers on depression. Although depression has been discussed as one of the central nervous system (CNS) side effects of β-blockers (Griffin and Friedman, 1986; Gerstman et al., 1996), however current studies contradicts the earlier findings which may be due to the lipophilic β-blockers like propranolol (logP 1.2) (Kaiserman et al., 2006; Verbeek et al., 2011). Recent years have witnessed an increased interest in the role of free radical oxidative damage in human diseases.
Pre implantation psychological functioning preserved in majority of implantable cardioverter defibrillator patients 12 months post implantation
2013, International Journal of CardiologyCitation Excerpt :One might speculate that the reduced prescription of beta-blocker therapy in shocked versus non-shocked patients might explain the larger deterioration in psychological functioning in shocked patients. However, there is little evidence to support a link between beta-blocker therapy and depression and anxiety [31, 32]. Moreover, although ICD shock likely still represents a critical event to many individual patients [3], the findings presented here and from the DEFINITE and SCD-HeFT trials emphasize that we should also look beyond ICD shocks to increase our understanding of patients at risk of poor patient reported outcomes (PROs; e.g. quality of life and distress), as shock only explains a marginal proportion of the variance in declines in these outcomes [2, 11, 29].
Reinitiation of Electroconvulsive Therapy 4 Weeks After the Diagnosis of ECT-Induced Takotsubo Cardiomyopathy
2019, PsychosomaticsCitation Excerpt :Despite the role that beta blockers may play in ECT, consideration to their effect on depression has also been explored historically.19,20 In a review of the literature investigating beta blockers and depression, studies varied in their method of measuring depression, with some studies using clinical diagnoses and others monitoring the presence of an antidepressant prescription.20 Reports suggest that more lipophilic beta blockers are more able to cross the blood–brain barrier and are thus more likely to contribute to depression.20
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From February 1, 2011: Department of Internal Medicine, University Medical Center Groningen, Huispost AA 41, PO Box 30.001, 9700 RB Groningen, The Netherlands.