Beta blockers leading to depression?

Had dinner with a psychologist friend last night who made the assertion that long-term usage of beta blockers is associated with onset of depression. While she said “beta blockers,” she was referring to my Inderal (propranolol) prescription.

Needless to say, having been taking propranolol for years now, and being very happy with what it’s done for me, I was not at all pleased to hear this. Also, I’ll note, after said several years, I’m not the least bit depressed.

She’s a mental health Ph.D., and I’m not. So I was able only to listen, and assume she knew of which she spoke.

So, how about it, TM? Is there any evidence to indicate that propranolol usage can induce a depressive state?

If so, is there a special set of conditions with which this is associated? I ask this because, although she wasn’t clear about this (i.e., she made the blanket statement about beta blockers several times without qualification), she did at one point seem to indicate that she might be referring specifically to pre-menopausal women.

The latest research does not support her conclusion. Here’s one of many cites. Just google “beta-blockers” and “depression”

QtM, MD

from:http://www.medscape.com/viewarticle/441556_8

She’s a mental health Ph.D., and I’m not. So I was able only to listen, and assume she knew of which she spoke.

I assume she is not a physician. She, therefore has no experience with prescribing ANY drug. It sounds to me as if she’s setting you up.

Propranolol is one of the older beta blockers. It has been studied many times, both alone and in concert with other medications. Even though I can’t claim to read every drug study, I have read some. I’ve participated in drug interaction studies, including one using propranolol. I don’t recall hearing or reading about it causing any emotional or psychological problems.
Peri-menopause is a very multi-faceted condition, with physical as well as psychological concerns. Pointing to one medication as a cause of any symptom is short sighted at best.

Thanks, Qadgop and picunurse. While I’m a relieved to get the feedback, it leaves me a little disturbed with my friend, whose authority I’ve never doubted before. I guess I’ll have to diplomatically suggest she refresh her knowledge of propranolol.

IANAD but I can’t see how anyone can’t see the potential relationship between a beta-blocking drug and depression. The noradrenergic systems are intricately linked with the dopaminergic and sertonergic systems. Most biochemical theories of depression have always included norepinephrine as a potential culprit. If I’m not mistaken, they are working on selective norepinephrine reuptake inhibitors for depression. The chemistry of mood is very different from person to person and what qualifies as a “good mood” also varies from person to person. The depression to your CNS alone as a result of taking beta blockers might make some people “feel depressed.”

Here is a little something:

http://reboxetine.com/norepi.html

http://reboxetine.com/nordep.html

Kid
Your reseachers don’t seem to have medical credentials.

OK, layman wading out into water over his head here.

So, as I understand it, beta blockers block noradrenergic nuerotransmitter activity. Right? Some, all, specific subsets thereof? Layman appreciation is that they can do this by occupying receptor sites, accelerating reuptake at the synapse or possibly binding with the neurotransmitters themselves. Are any of those mechanisms right?

Said blocking can do a variety of things, one important thing being to slow heart rate.

To simplify my take on what KidCharlemagne linked to, apparently depression treatments that enhance the availabilty of (some?) noradrenergic neurotransmitters appear to be effective. I’d guess the relationship KC suspects may be implied is that if more noradrenergic neurotransmitter makes for a less depressed individual then less noradrenergic neurotransmitter makes for a more depressed individual.

I suspect that’s far too simple an appreciation of what’s involved.

As long as we’re at it, if there are betas to be blocked, that implies that there are also alphas. What is the difference/relationship between alpha and beta here.

All that being said, in my patently ignorant manner (awaiting enlightenment, TM), it nevertheless appears that statistical evidence indicates no significant correlation between beta blockers and depression.

**Kid
Your reseachers don’t seem to have medical credentials. **
[/QUOTE]

Abstracts from the Journal of Clinical Psychiatry don’t classify as a legitimate cite?

What exactly about what I said do you doubt?

You doubt the potential effect of blocking beta receptors or screwing with norepinephrine levels on depression?



There was one “metastudy” done by some cardiologist who said there was no substantial evidence for a substantial increased risk for depression for taking betablockers. IMO, this study is a joke but have at it:

So you have one cardiologists meta study vs. the obvious and documented association of norepinephrine activity and depression and countless clinical observations and you’re not willing to make the conceptual leap that something that blocks adrenaline’s uptake might not cause depression in some people???

I take another beta-blocker—atenolol. My HMO gives out patient education sheets and mine says:

“Possible Side Effects
Side Effects That Should Be Reported To Your Doctor
Less Common—Difficulty in breathing, cold hands and feet, mental depression, shortness of breath, slow heartbeat, swelling of ankles, feet, or lower legs.”

So I get to feeling depressed on occasion. Usually when my heartbeat gets below the mid 40s. (It’s been evaluated and I’m supposed to be okay.) I just get up and move around—walk, anything, and that fixes it.

Ringo, what I should have mentioned is that if you are taking it and not getting depressed you are in the majority and from what psychopharmacologists have told me you would feel depressive symptoms in days/weeks, not years. Inderal is a great drug - I just wanted to point out that no clinical trials does not mean no clinical evidence or the existence of a reasonable conceptual leap.

So show us a study that demonstrates that use of beta-blockers causes an increased incidence of depression. Not a mechanism that shows how it could, but data that shows that it does.

We have hundreds of thousands of people on beta blockers, and for many, especially heart disease patients, they are life-saving. With numbers like that, a study should show some evidence of whether or not it causes more depression. The study I cited showed no such evidence.

But I’m willing to be convinced. Give me the clinical data. I haven’t found any good clinical data that shows it does yet. But my search has not been exhaustive.

The clinical data isn’t conclusive. There is the one metastudy of crossreferencing “depression” with various beta-blocker names that indicates there is no correlation. Weak method. There is another study that attempts to correlate anti-depressant prescriptions with beta blocker prescriptions that says there is a slight correlation. Again, weak method.
My first post was really a reaction to picunurse’s post which seemed to be saying that the very idea was ridiculous. There has obviously been enough clinical observation of the phenomenom to generate speculation about a link. In matters of the mind and mood, I have noticed that psychopharmacologists tend to rely much more on clinical experience than clinical trials. After reviewing my posts I decided that they weren’t in the spirit of answering the OP’s question and so made a qualifying post. In other words, I’d never tell someone taking propanolol that they should watch out for signs of depression. If, however, someone started experiencing symptoms of depression after recently beginning treatment with inderal, I’d say there is certainly a reasonable basis for a thesis as to why that might be.

But I guess what really bugged me was the comment about my first cites lacking credentials.

My doctor told me when he gave me beta-blockers (topronol?) that some people get depressed and I should give him a call if I had any problems. I actually got severely depressed during the 3 days I was on them and will not touch them with a ten foot pole (cross my 100 beats per minute heart).

I disagree with this conclusion Picunurse. Ph.Ds know just as much about their area of expertise as physicians, and should stay even more up to date on the latest publications. I’m a Ph.D student and am confident I know more about how proteins I solve the structure of relate to cancer than any physician. I know that physicians are the quarterbacks and wide receivers on the team of Medicine and scientists are just the offensive linemen, but give us a little credit!

Well, I have been using one or another beta blocker for the last 30 years. For the first decade, I was using inderal, 4 times a day. Then I was switched to a different one (lopressor) that I used only twice a day. After a second decade, I was switched to betaloc that I need take only once a day. And I realized (by what happens to my heart rate if I forget) that it actually lasts about a day and a half. Not the merest smidgeon of depression. The side effects that I have noticed are first and most unpleasant, cold hands and feet. Second it changed my sleeping habits overnight, from being a night person who really liked at least 8 hours of sleep a night, preferably ending at noon, to a morning person who had trouble staying up till midnight and woke up bright and cheerful after 6 (sometimes 4 or 5) hours of sleep.

But that is just one person’s experience and not necessarily indicative of anything. Also I feel I have always been even-tempered, which is not always positive since I miss the highs as well as the lows.

IANAD and this is purely anecdotal. I took Inderal for three or four years. I have a genetic predisposition to depression and have struggled with it for years so I wouldn’t have associated any symptoms with this medication.

What I DID definitely see was that it zapped my energy. Within a matter of days after I stopped taking it, I actually begin to feel like doing something besides sitting on the sofa. After almost twenty years, I can remember the exact moment that the “curtain” seemed to lift.

Not feeling like doing anything was depressing to me.

Hmmm…, Zoe, I feel just the opposite. I tend to feel more energized with the Inderal. To each his own, I guess.

Qadgop the Mercotan - don’t the listed side effects for most drugs include both observed, predicted and merely reported issues?

That is, if enough people squawk, that complaint will be listed even if no one can find any real evidence that there’s a problem?