The Science behind the Tip

The methodological quality of early studies of the association of systemic or topical β-blocker therapy and depressed mood is weak. Most of the evidence supporting an association has used case reports or short series. Further, the mechanism by which β-blockers might induce depression remains unclear. Lipophilic β-blockers easily penetrate the blood-brain barrier and should thus cause more central nervous system disturbances than hydrophilic ones. Yet, relative lipophilicity has not proved to play a role (1,2).

The increased use of β-blockers in recent years in the treatment of myocardial infarction and heart failure has lead to renewed interest in the matter. Several syntheses of the data (3) and a meta-analysis of randomized clinical trials (2) have shown that the association is much weaker than originally believed and might even be non-existent. Additionally, a recent multicenter prospective study of 381 post-myocardial infarction patients could not demonstrate an association in the first year of treatment (4).

In line with the cardiovascular literature, a retrospective observational population-based cohort study found no effect of topical β-blockers on the prevalence of depression among glaucoma patients (5).

Contributor: Ann Hoste, Antwerp

References

1. Gengo FM, Gabos C. Central nervous system considerations in the use of beta-blockers, ACE-inhibitors, and thiazide diuretics in managing essential hypertension. Am Heart J. 1988;116:305-10.

2. Ko DT, Hebert PR, Coffey CS, et al. Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction. JAMA. 2002;288:351-7.

3. Ried LD, McFarland BH, Johnson RE, Brody KK. Beta-blockers and depression: the more the murkier? Ann Pharmacother. 1998;32:699-708.

4. van Melle JP, Verbeek DE, van den Berg MP, et al. Beta-blockers and depression after myocardial infarction: a multicenter prospective study. J Am Coll Cardiol. 2006;48:2209-14.

5. Kaiserman I, Kaiserman N, Elhayany A, et al. Topical beta-blockers are not associated with an increased risk of treatment for depression. Ophthalmology. 2006; 113:1077-80.

You can find the abstracts here.