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Antidepressant Use in Patients Prescribed β-Blockers

Marc Stone, MD
JAMA. 1986;255(23):3248. doi:10.1001/jama.1986.03370230054020.
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To the Editor.—  In the Jan 17 issue, Avorn and colleagues1 give valuable evidence of an association of β-blocker and tricyclic antidepressant (TCA) use. In their discussion in the article and in reports in the news media, much emphasis was placed on one explanation: β-blockers cause depression. Their enthusiasm for this explanation is understandable. If correct, the authors have uncovered a large area of preventable morbidity. This enthusiasm may have clouded their consideration of other very plausible explanations.There are a number of ways in which the presence of depression or TCA use would cause physicians to prefer β-blockers. Methyldopa and clonidine have anticholinergic side effects similar to those of tricyclic antidepressants and may add to them. Physicians may have believed other antihypertensive agents to be more likely to cause or aggravate depression than β-blockers and avoided them. Reserpine has a widespread (and possibly unjustified) reputation for causing depression. Clonidine

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