What Is A Beta
Beta-blockers are prescribed medicines, such as atenolol , bisoprolol , and propranolol , that work by blocking adrenaline, reducing blood pressure, and slowing down the heart. They are mostly used to treat cardiac problems and high blood pressure. Less common uses include anxiety, hyperthyroidism, tremor, and glaucoma.
However, the data was less conclusive on other reported side effects, such as insomnia, sleep disorders, and unusual dreams. Researchers also found that patients who chose to stop taking the medication most commonly cited fatigue as the cause.
“Beta-blockers are very commonly prescribed drugs, and their possible psychiatric adverse events have been the subject of discussion in the scientific community for more than 50 years,” study author Thomas G. Riemer, MD, PhD, a researcher from Charité Universitätsmedizin Berlin and the Berlin Institute of Health, Institute of Clinical Pharmacology and Toxicology, tells Verywell. “Therefore, our results showing that beta-blockers are not causing most of their alleged side effects are quite consequential.”
The study was published in mid-March in Hypertension, an American Heart Association journal.
Study Design And Data Source
We conducted a matched casecontrol analysis using primary care data from the UK-based Clinical Practice Research Datalink GOLD obtained under license from the UK Medicines and Healthcare Products Regulatory Agency. The database encompasses approximately 11.3 million electronic patient records from around 650 practices . The data are collected by the National Health Service as part of the routine care by general practitioners . Available information includes medical diagnoses, demographics, lifestyle factors, and referrals to secondary care. Individuals registered in the CPRD are representative of the UK population in terms of age, sex and ethnicity. The data quality and completeness of the CPRD has been extensively validated .
The UK-CPRD study is based on data from the CPRD obtained under license from the UK Medicines and Healthcare Products Regulatory Agency. The data are provided by patients and collected by the NHS as part of their care and support. This study was approved by the Independent Scientific Advisory Committee for Medicines and Healthcare Products Regulatory Agency database research and has been made available to the journal editors. The interpretation and conclusions contained in this study are those of the author/s alone.
Heterogeneity And Publication Bias
Given the obvious heterogeneity shown in the forest plots, the sensitivity analysis was conducted by omitting one study at a time . In line with the results earlier mentioned, associations between angiotensin antagonists and diuretics use and depression were little, and the result was not excessively influenced by any single study . After removing the study by Simonson et al., a significant association between use of beta blockers and depression was observed with the heterogeneity decreasing from 85 to 40% . When the study by Cao et al. was excluded, no association was found between calcium channel blockers usage and depression .
To evaluate publication bias, funnel plots were constructed. No publication bias was found in the beta blockers group , while apparent biases were found in the other three groups .
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Depression Rates In People Taking Different Blood Pressure Drugs
To see if commonly prescribed blood pressure drugs might influence a person’s risk of developing depression, Danish researchers scrutinized a decade’s worth of data from their national health registry. Their findings, summarized below, were published in the September 2020 issue of Hypertension.
Who: All 5.4 million people living in Denmark in 2005, except for those diagnosed with depression or prescribed an antidepressant medication.
When: Researchers tracked the participants’ health from 2005 to 2015.
What: Just over 3.7 million people received a prescription for a blood pressure drug during the 10-year study period. Researchers focused on 41 drugs from four different classes of blood pressure drugs. Diuretics were the most commonly prescribed, followed by ACE inhibitors and ARBs, calcium-channel blockers, and beta blockers.
How: In people taking the different medications, researchers assessed the rate of depression, which was determined by a diagnosis by a clinician or use of antidepressants.
Key findings: None of the diuretics appeared to affect depression risk. In each of the other drug classes, at least two drugs were linked with a lower risk of depression: enalapril , ramipril , amlodipine , verapamil , propranolol , atenolol , bisoprolol , and carvedilol .
Study: Beta Blockers Won’t Cause Depression But Are Linked To Sleep Issues
Millions of people take a beta blocker regularly, and a new study brings good news: The medications will not raise the risk of depression.
Beta blockers are used to treat conditions such as heart failure, chest pains, high blood pressure and abnormal heart rhythm.
But it’s long been suspected that the drugs may be linked with depression, anxiety, drowsiness, insomnia, hallucinations and nightmares.
The new German study involved more than 50,000 people. It found no connection between beta blockers and mental health issues, although there was a suggestion the meds could interfere with sleep.
“We found no indication of an association between beta blocker use and depression,” said study supervising author Dr. Reinhold Kreutz. He’s a professor at the Berlin Institute of Health’s Institute of Clinical Pharmacology and Toxicology.
“The same was true for most of the other mental health symptoms, as reported in the studies that were included in our analyses,” Kreutz added. “However, sleep-related symptoms such as unusual dreams or insomnia did emerge during beta blocker therapy for some patients.”
Dr. Michael Goyfman directs clinical cardiology at Long Island Jewish Forest Hills in New York City. He wasn’t involved in the study, but called it “particularly convincing, since the authors used only double-blind, randomized controlled trials.”
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Can Medications Given For A Heart Attack Cause Depression
Dr. Richard Stein answers the question: ‘Can Beta Blockers Cause Depression?’
& #151 — Question: Can medications given for a heart attack cause depression?
Answer: Beta blockers are, for a cardiologist, a sort of the rock and the hard place thing. They reduce your risk of having a second heart attack and of dying of it, so it’s really a compelling medication for us to use. But they clearly can increase your risk of becoming depressed and staying depressed on the medication. So what you need to do is to tell your cardiologist about this, and your cardiologist should actually ask you about this, and your doctor should talk to you about it — and adjust the doses or add some drugs to take care of the depressive side of it at the same time.
Interpretation Of The Results
On the surface, this very large meta-analysis21 of placebo arm and active arm parallel group RCTs provides strong evidence for the absence of risk of new-onset depression following initiation of BB treatment. So, what is the reason for the longstanding clinical concern that BB treatment is associated with an increased risk of developing depression?
There are 2 explanations. One is that it is well known that IHD and depression are each associated with an increased risk of the other,22,23 and IHD is an important indication for the initiation of BB treatment. So, confounding by indication may explain clinical observations of new-onset depression after initiation of BBs in patients with IHD. The second explanation is that tiredness/fatigue and unusual dreams, which Riemer et al21 found to be significantly more common with BBs, are common symptoms of depression and may be misinterpreted and misreported as depression.
Riemer et al21 wrote in their abstract that insomnia and sleep disorder were other psychiatric adverse events that were possibly related to BB therapy. Whereas neither adverse event emerged as a significant finding in the main quantitative analyses for either placebo- or active-controlled comparisons, there were some significant or near-significant associations with BB treatment in sensitivity and subgroup analyses. So, insomnia and sleep disorder may additionally contribute to the possibility of nonspecific adverse events being misinterpreted as depression.
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Characteristics Of The Study Population
We identified 118,705 cases with a first-time diagnosis of pharmacologically treated depression between 2000 and 2016, and the same number of matched controls. The majority of cases had a depression episode without further classification, but severe enough to be treated with antidepressant therapy. Patients had a mean age of 40.3 years at the index date and the majority were female . The mean duration of active history in the database prior to the index date was 11.3 years .
Table 1 Characteristics of the study population
Can You Drink Alcohol While Taking Beta
Its best to avoid drinking alcohol if you take beta-blockers.
Both beta-blockers and alcohol can lower your blood pressure. Combining the two could cause your blood pressure to drop too quickly. This could leave you feeling weak, dizzy, or lightheaded. You might even faint if you stand up too fast.
Of course, these side effects depend on both your prescribed dose of beta-blockers and how much you drink. While theres no completely safe combination, having an occasional alcoholic drink may be less risky. But its best to check with your doctor first.
You should also talk with your doctor if avoiding alcohol is difficult for you. Other medications may be available.
Beta-blockers arent for everyone. They may pose a greater risk to people with the following conditions:
- asthma, COPD, and other lung diseases
Talking to your doctor about your health and any medical conditions may help you avoid negative side effects.
- Let your doctor know if youre pregnant, trying to get pregnant, or breastfeeding.
- To prevent drug interactions, provide your doctor with a list of all the medications and supplements you take.
- Be honest about your alcohol, tobacco, and drug use. These substances can interact with beta-blockers.
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Antihypertensive Drug Use And The Risk Of Depression: A Systematic Review And Network Meta
- 1State Key Laboratory of Natural Medicines, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
- 2Department of Cardiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China.
Background: Although numerous cohort studies have reported an association between antihypertensives use and depression, the exact effect of antihypertensives on depression remains unclear.
Objective: To clarify the association between antihypertensives use and risk of depression.
Methods: We retrieved relevant literature using PubMed database until August 30, 2021. Four main classes of antihypertensives, thus, angiotensin antagonists, beta blockers, calcium channel blockers and diuretics were studied. The incidence of depression was pooled based on a single drug category. Network meta-analyses were conducted to comprehensively assess the effects of the four classes of antihypertensives on the risk of depression.
In conclusion, our results indicate that the use of angiotensin antagonists, beta blockers and calcium channel blockers are potential risk factors of depression.
Study Selection And Characteristics
The workflow of study selection is illustrated in Figure 1. In brief, a total of 9,557 publications were retrieved from the PubMed database, and 9 studies consisting 6 cross-sectional studies and 3 cohort studies were finally involved in this study .
FIGURE 1. Flow chart of published studies included and excluded in this study.
Characteristics of selected publications are presented in Table 1. Overall 414,873 individuals were included in the final analysis. The sample sizes ranged from 573 to 181,709 individuals. Subjects were recruited from a total of 10 countries, including Australia, China, Germany, Netherlands, Norway, Singapore, the United Kingdom and the United States. Of note, the methods used to assess depression or symptoms of depression varied across the nine studies. The two main diagnostic classification systems were Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases . In all nine studies, three studies identified depression based on these two criteria .
TABLE 1. Characteristics of included studies.
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Side Effects Of Beta Blockers
Most people taking beta blockers have either no or very mild side effects that become less troublesome with time.
Contact your GP if you’re having symptoms that bother you or last more than a few days.
Side effects commonly reported by people taking beta blockers include:
- feeling tired, dizzy or lightheaded
- cold fingers or toes
- difficulties sleeping or nightmares
It happens rarely, but some people have serious side effects when taking beta blockers.
Tell a doctor straight away if you have:
- shortness of breath with a cough that gets worse when you exercise , swollen ankles or legs, chest pain, or an irregular heartbeat these are signs of heart problems
- shortness of breath, wheezing and tightening of your chest these can be signs of lung problems
- yellow skin or the whites of your eyes turn yellow these can be signs of liver problems
These are not all the side effects of beta blockers. For a full list, see the leaflet inside your medicine packet.
You can report suspected side effects using the Yellow Card Scheme.
For more information on the side effects of beta blockers, read about the specific medicine you take in our Medicines A to Z.
Who Can Take Beta Blockers
Beta blockers are not suitable for everyone. To make sure they are safe for you, tell your doctor before starting a beta blocker if you have:
- had an allergic reaction to a beta blocker or any other medicine in the past
- low blood pressure or a slow heart rate
- serious blood circulation problems in your limbs
- metabolic acidosis when there’s too much acid in your blood
- lung disease or asthma
Tell your doctor if you’re trying to get pregnant, are already pregnant or breastfeeding.
It’s important not to stop taking beta blockers without seeking your doctor’s advice. In some cases suddenly stopping the medicine may make your health condition worse.
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Search Strategy And Selection Criteria
We searched the PubMed database using and expanding the MeSH terms antihypertensive agents and depression until August 30, 2021. The full search terms were illustrated in Supplementary Appendix S1. Literature retrieval was limited to human studies published in English. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for systematic reviews were followed and fulfilled . Publication that simultaneously fulfilled the following criteria were included in our study: 1) control groups were users of other classes of medication and/or nonmedicated participants 2) studies that used a validated method to assess depression or symptoms of depression, and the measure of depression was used as a categorical variable rather than a continuous variable and 3) studies with sample size of more than 100, so as to avoid selection bias. The selection of relevant literature was independently conducted by two researchers, and disagreements were resolved by consulting a third reviewer.
Is It Safe To Stop Using Beta
Its dangerous to stop taking beta-blockers suddenly, even if youre experiencing side effects.
When you take beta-blockers, your body gets used to your hearts slower speed. If you stop taking them suddenly, you could increase your risk of a serious heart problem, such as a heart attack.
Contact your doctor if you experience unpleasant side effects with beta-blockers that last for more than a day or two. Your doctor might suggest another type of medication, but youll still need to slowly taper your beta-blocker dose.
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Data Extraction And Quality Assessment
For all eligible studies, two researchers independently extracted the following data: the first author, PMID, the year of publication, country, study type, sample age range, percentage of males, the methods used to define depression, odds ratio or relative risk and the corresponding 95% CI, as well as control variables for adjustment. For the analysis model used in the studies, we gave priority to multivariate analysis or adjusted OR/RR values over univariate analysis or crude results. If the studies failed to report OR/RR, the raw data were reviewed to determine whether the OR/RR could be calculated. Different antihypertensive medication stratifications were treated as several independent results with corresponding populations separately. If there was stratification by the number of antihypertensive agents, the effect estimates were regarded as independent results separately.
Statins And Other Lipid
Why they’re prescribed: Statinsare the class of drugs most commonly prescribed to lower cholesterol levels, followed by fibrates and other drugs, such as ezetimibe, colesevelam and nicotinic acid.
How they can cause depression: Recent research suggests that lipid-lowering drugs may cause depression by depleting levels of cholesterol in the brain, where it plays an important role in the release of neurotransmitters.
Alternatives: A combination of vitamin B12 , vitamin B6, folic acid and fish oil can lower homocysteine levels in the body. Homocysteine, an amino acid, inflicts damage to the inner arterial lining and other cells of the body, elevating lipids levels. While there are many studies that substantiate this nondrug approach and many that reject it, I’ve found that it works consistently well in older patients without posing the risk of serious side effects.
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Proton Pump Inhibitors And H2 Blockers
Why they’re prescribed: Doctors typically prescribe these medications, which suppress the secretion of gastric acid, to treat gastroesophageal reflux disease .
How they can cause depression: While these drugs are known to cause depression, scientists don’t yet understand why they do. When any major body process is blocked, however, the body often rebels in an intense effort to fight back. Consequently, it’s altogether likely that changing the pH of the stomach could bring on changes to the central nervous system and the brain.
Alternatives: Know which foods trigger your acid reflux and avoid them, especially in the hours before bedtime. A non-calcium-carbonate-based antacid, such as Mylanta, may also help. Many of my patients have reported relief from the home remedy of apple cider vinegar and honey , though I know of no scientific research that confirms the effectiveness of this approach.