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Antidepressant Use in Patients Prescribed β-Blockers-Reply

Jerry Avorn, MD; Daniel E. Everitt, MD
JAMA. 1986;255(23):3249-3250. doi:10.1001/jama.1986.03370230054024.
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In Reply.—  In general, we agree with the concerns expressed in several of the letters that our findings indicating a higher frequency of treatment for depression in patients taking β-blockers is an initial cross-sectional study that, as we noted in several places in the article, will need to be further documented in subsequent investigations before it can be considered "proved." However, several specific comments require further discussion. The rare occurrence of migraine in the population studied (<1/ 100,000) makes it unlikely that the simultaneous treatment of such patients with β-blockers and antidepressants was frequent enough to account for the findings described. While Dr Scollins is correct that for many patients pharmacokinetic considerations cause an increase in drug effect with aging, for the β-blockers there is in fact a countervailing decrease in pharmacodynamic effect, owing to diminished receptor sensitivity to these drugs with advancing age.1 We concur with Dr Stone


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