Beta-blockers not tied to depression; sleep disorder link less clear

Beta-blockers were not associated with depression and other psychiatric adverse events, although they may have a relationship with sleep disorders, according to a meta-analysis.

“This analysis of large-scale data from double-blind, randomized controlled trials does not support an association between beta-blocker therapy and depression. Similarly, no effect for beta-blockers was found for other psychiatric adverse events, with the possible exceptions of sleep-related disorders,” the researchers wrote.

Beta-blocker therapy was linked to unusual dreams and insomnia, the researchers wrote.

“The possible psychiatric sequelae of beta-blockers, most importantly depression, have been subject of discussion in the scientific community for more than 50 years. The medical literature including books on clinical pharmacology, cardiovascular medicine, and psychiatry lists depression among the adverse events for beta-blockers,” Thomas G. Riemer, MD, PhD, from the Charité – Universitätsmedizin Berlin and the Berlin Institute of Health, Institute of Clinical Pharmacology and Toxicology, told Healio. “Several case reports of depression apparently induced by beta-blockers have been published. Depression also is to date frequently reported in both the American and the European postmarketing surveillance systems.”

Researchers conducted a systemic review and meta-analysis of 53,533 patients from 285 studies who were taking various beta-blockers, most of whom had CVD.

Compared with placebo, the risk for depression was no higher with beta-blocker therapy (OR = 1.02; 95% CI, 0.83-1.25; P = .88).

The researchers wrote that the rate of discontinuing medications due to depression was the same for people taking beta-blockers compared with placebo (OR = 0.97; 95% CI, 0.51-1.84; P = .91).

According to the researchers, most of the trials were conducted in patients with CVD, with the most common indication being arterial hypertension (32,042 patients on beta-blockers in 197 trials) then MI, HF and angina.

The most noticeable nonvascular indication was migraine (1,313 patients in 19 trials).

“Patients with a history of cardiovascular events such as a heart attack or stroke were prone to develop psychological complications. Though we found beta-blockers were not causally linked, these patients should be monitored,” Reinhold Kreutz, MD, PhD, professor at the Berlin Institute of Health, Institute of Clinical Pharmacology and Toxicology, said in a press release.

“The process of choosing a drug to treat a medical condition always contains a benefit-risk assessment. In the past, beta-blockers have had the stigma of being harmful for psychological health, which may have discouraged their use, in patients deemed vulnerable to psychiatric diseases. Our results indicate that concerns about psychiatric adverse events, especially depression, should not affect the decision whether or not to use beta-blockers,” Riemer told Healio.

For more information:

Thomas G. Riemer, MD, PhD, can be reached at thomas.riemer@charite.de.