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April 1, 1992, Vol 267, No. 13 >
ARTICLE | April 1, 1992

β-Blockers and Depression: Title and subTitle BreakThe Clinician's Dilemma FREE

Stuart C. Yudofsky, MD
[+] Author Affiliations

Reprint requests to Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Room 115-D, Houston, TX 77030 (Dr Yudofsky).


JAMA. 1992;267(13):1826-1827. doi:10.1001/jama.1992.03480130142042
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References

Since their introduction over a quarter of a century ago, β-adrenergic receptor antagonists (β-blockers) have been among the most commonly prescribed and useful of all medications.1 Beyond their cardiovascular applications in the treatment of hypertension, arrhythmias, and angina pectoris, and for the prophylaxis of myocardial infarctions in those who have suffered a prior myocardial infarction, β-blockers are currently and increasingly being used for a broad variety of other conditions ranging from performance anxiety, migraine headaches, glaucoma, hyperthyroidism, and hand tremors to the treatment of rage and violent behavior in individuals with brain lesions or injury. Briefly following the introduction of β-blockers, reports appeared in the medical literature associating their use with clinical depression. One of the earliest and most frequently cited articles reported a 50% incidence of depression in patients who had received 120 mg/d of propranolol hydrochloride for periods extending beyond 3 months.2

See also p 1783.

REFERENCES

1 +
Hoffman BB, Lefkowitz RJ.  Adrenergic receptor antagonists.  In: Gilman AG, Rail TW, Nies AS, Taylor P, eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics . 8th ed. New York, NY: Pergamon Press Ltd; 1990;:221-243.
2 +
Waal HJ.  Propranolol-induced depression. BMJ . 1967;;2:50.
3 +
Myers JK, Weissman MM, Tischler GL, et al.  Six-month prevalence of psychiatric disorders in three communities: 1980-1982. Arch Gen Psychiatry . 1984;;41:959-967.
4 +
Guze SB, Robins E.  Suicide and primary affective disorders. Br J Psychiatry . 1970;;117:437-438.
5 +
Stoudemire A, Brown JT, Harris RT, et al.  Propranolol and depression: a reevaluation based on a pilot clinical trial. Psychiatr Med . 1984;;2:211-218.
6 +
Banerjee SP, Kung LS, Riggi SJ, Chanda SK.  Development of β-adrenergic receptor subsensitivity by antidepressants. Nature . 1977;;268:455-456.
7 +
Hallberg H, Almgren O, Svensson TH.  Reduced brain serotonergic activity after repeated treatment with β-adrenoceptor antagonists. Psychopharmacology . 1982;;76:114-117.
8 +
Koella WP.  CNS-related side effects of β-blockers with special reference to mechanisms of action. Eur J Clin Pharmacol . 1985;;28( (suppl) ):55-63.
9 +
Lecrubier Y, Puech AJ, Jouvent R, Simon P, Widlocher D.  A beta adrenergic stimulant (salbutamol) versus clomipramine in depression: a controlled study. Br J Psychiatry . 1980;;136:354-358.
10 +
Petrie WM, Maffucci RJ, Woolsey RL.  Propranolol and depression. Am J Psychiatry . 1982;;130:92-94.
11 +
Carney RM, Rich MW, te Velde A, Saini J, Clark K, Freedland KE.  Prevalence of major depressive disorder in patients receiving beta-blocker therapy versus other medications. Am J Med . 1987;;83:223-226.
12 +
Blumenthal JA, Madden DJ, Frantz DS, et al.  Short-term behavioral effects of beta adrenergic medications in men with mild hypertension. Clin Pharmacol Ther . 1988;;43:429-435.
13 +
Avorn J, Everitt DE, Weiss S.  Increased antidepressant use in patients prescribed β-blockers. JAMA . 1986;;255:357-360.
14 +
Thiessen BQ, Wallace SM, Blackburn JL, Wilson TW, Bergman UIF.  Increased prescribing of antidepressants subsequent to β-blocker therapy. Arch Intern Med . 1990;;150:2286-2290.
15 +
Wurzelmann J, Frishman WH, Aronson M, Masur D, Ooi WL.  Neurophychological effects of antihypertensive drugs. Cardiol Clin . 1987;;5:689-701.
16 +
Bright RA, Everitt DE.  β-Blockers and depression: evidence against an association. JAMA . 1992;;267:1783-1787.
17 +
Kostis JB, Rosen RC.  Central nervous system effects of β-adrenergic-blocking drugs: the role of ancillary properties. Circulation . 1987;;75:204-212.
18 +
Drayer DE.  Lipophilicity, hydrophilicity, and the central nervous system effects of beta blockers. Pharmacotherapy . 1987;;7:87-91.
19 +
McAinsh J, Cruickshank JM.  Beta-blockers and central nervous system side effects. Pharmacol Ther . 1990;;46:163-197.
20 +
Currie D, Lewis RV, McDevitt DG, Nicholson AN, Wright NA.  Central effects of β-adrenoceptor antagonists: I-performance and subjective assessment of mood. Br J Clin Pharmacol . 1988;;26:121-128.
21 +
Westerlund A.  Central nervous system side-effects with hydrophilic and lipophilic β-blockers. Eur J Clin Pharmacol . 1985;;2( (suppl) ):73-76.
22 +
Fodor JG, Chockalingam A, Drover A, Fifield F, Pauls CJ.  A comparison of the side effects of atenolol and propranolol in the treatment of patients with hypertension. J Clin Pharmacol . 1987;;27:892-901.
23 +
Conant J, Engler R, Janowsky D, Maisel A, Gilpin E, LeWinter M.  Central nervous system side effects of β-adrenergic blocking agents with high and low lipid solubility. J Cardiovasc Pharmacol . 1989;;13:656-661.
24 +
Tang SW, Remington G, Persad E, Rosenblat R.  Coadministration of a beta-adrenergic antagonist and a tricyclic antidepressant: a pilot study. Psychiatry Res . 1990;;33:101-106.
25 +
Nemeroff CB, Evans DL.  Concurrent use of antidepressants and propranolol: core report and theoretical considerations. Biol Psychiatry . 1983;;18:237-241.
26 +
Silver JM, Yudofsky SC, Kogan M, Katz BL.  Elevation of thioridazine plasma levels by propranolol. Am J Psychiatry . 1986;;143:1290-1292.

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1 +
Hoffman BB, Lefkowitz RJ.  Adrenergic receptor antagonists.  In: Gilman AG, Rail TW, Nies AS, Taylor P, eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics . 8th ed. New York, NY: Pergamon Press Ltd; 1990;:221-243.
2 +
Waal HJ.  Propranolol-induced depression. BMJ . 1967;;2:50.
3 +
Myers JK, Weissman MM, Tischler GL, et al.  Six-month prevalence of psychiatric disorders in three communities: 1980-1982. Arch Gen Psychiatry . 1984;;41:959-967.
4 +
Guze SB, Robins E.  Suicide and primary affective disorders. Br J Psychiatry . 1970;;117:437-438.
5 +
Stoudemire A, Brown JT, Harris RT, et al.  Propranolol and depression: a reevaluation based on a pilot clinical trial. Psychiatr Med . 1984;;2:211-218.
6 +
Banerjee SP, Kung LS, Riggi SJ, Chanda SK.  Development of β-adrenergic receptor subsensitivity by antidepressants. Nature . 1977;;268:455-456.
7 +
Hallberg H, Almgren O, Svensson TH.  Reduced brain serotonergic activity after repeated treatment with β-adrenoceptor antagonists. Psychopharmacology . 1982;;76:114-117.
8 +
Koella WP.  CNS-related side effects of β-blockers with special reference to mechanisms of action. Eur J Clin Pharmacol . 1985;;28( (suppl) ):55-63.
9 +
Lecrubier Y, Puech AJ, Jouvent R, Simon P, Widlocher D.  A beta adrenergic stimulant (salbutamol) versus clomipramine in depression: a controlled study. Br J Psychiatry . 1980;;136:354-358.
10 +
Petrie WM, Maffucci RJ, Woolsey RL.  Propranolol and depression. Am J Psychiatry . 1982;;130:92-94.
11 +
Carney RM, Rich MW, te Velde A, Saini J, Clark K, Freedland KE.  Prevalence of major depressive disorder in patients receiving beta-blocker therapy versus other medications. Am J Med . 1987;;83:223-226.
12 +
Blumenthal JA, Madden DJ, Frantz DS, et al.  Short-term behavioral effects of beta adrenergic medications in men with mild hypertension. Clin Pharmacol Ther . 1988;;43:429-435.
13 +
Avorn J, Everitt DE, Weiss S.  Increased antidepressant use in patients prescribed β-blockers. JAMA . 1986;;255:357-360.
14 +
Thiessen BQ, Wallace SM, Blackburn JL, Wilson TW, Bergman UIF.  Increased prescribing of antidepressants subsequent to β-blocker therapy. Arch Intern Med . 1990;;150:2286-2290.
15 +
Wurzelmann J, Frishman WH, Aronson M, Masur D, Ooi WL.  Neurophychological effects of antihypertensive drugs. Cardiol Clin . 1987;;5:689-701.
16 +
Bright RA, Everitt DE.  β-Blockers and depression: evidence against an association. JAMA . 1992;;267:1783-1787.
17 +
Kostis JB, Rosen RC.  Central nervous system effects of β-adrenergic-blocking drugs: the role of ancillary properties. Circulation . 1987;;75:204-212.
18 +
Drayer DE.  Lipophilicity, hydrophilicity, and the central nervous system effects of beta blockers. Pharmacotherapy . 1987;;7:87-91.
19 +
McAinsh J, Cruickshank JM.  Beta-blockers and central nervous system side effects. Pharmacol Ther . 1990;;46:163-197.
20 +
Currie D, Lewis RV, McDevitt DG, Nicholson AN, Wright NA.  Central effects of β-adrenoceptor antagonists: I-performance and subjective assessment of mood. Br J Clin Pharmacol . 1988;;26:121-128.
21 +
Westerlund A.  Central nervous system side-effects with hydrophilic and lipophilic β-blockers. Eur J Clin Pharmacol . 1985;;2( (suppl) ):73-76.
22 +
Fodor JG, Chockalingam A, Drover A, Fifield F, Pauls CJ.  A comparison of the side effects of atenolol and propranolol in the treatment of patients with hypertension. J Clin Pharmacol . 1987;;27:892-901.
23 +
Conant J, Engler R, Janowsky D, Maisel A, Gilpin E, LeWinter M.  Central nervous system side effects of β-adrenergic blocking agents with high and low lipid solubility. J Cardiovasc Pharmacol . 1989;;13:656-661.
24 +
Tang SW, Remington G, Persad E, Rosenblat R.  Coadministration of a beta-adrenergic antagonist and a tricyclic antidepressant: a pilot study. Psychiatry Res . 1990;;33:101-106.
25 +
Nemeroff CB, Evans DL.  Concurrent use of antidepressants and propranolol: core report and theoretical considerations. Biol Psychiatry . 1983;;18:237-241.
26 +
Silver JM, Yudofsky SC, Kogan M, Katz BL.  Elevation of thioridazine plasma levels by propranolol. Am J Psychiatry . 1986;;143:1290-1292.

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