Posted by SalArmy4me on July 20, 2001, at 1:36:49
In reply to Re: beta blockers for anxiety/panic? , posted by PaulB on July 17, 2001, at 16:08:59
Paauw, Douglas S. MD. Did We Learn Evidence-Based Medicine in Medical School? Some Common Medical Mythology. Journal of the American Board of Family Practice. 12(2):143-149, March/April 1999:
"Myth 4: beta-Blockers are an important cause of depression.
Early reports of possible beta-blocker-induced depression surfaced soon after the beta-blocker propranolol became available in the 1960s. A frequently cited reference is a letter published in the British Medical Journal in which Waal [22] reported that 20 of 89 patients on propranolol volunteered or exhibited depressive symptoms. Forty percent of these cases were classified as grade 1 depression-symptoms of irritability, insomnia, nightmares, and fatigue. No control group of patients was evaluated to ascertain the prevalence of these symptoms in patients treated with other antihypertensive medications or in nonhypertensive patients. Pollack et al [23] described a series of 3 patients who developed symptoms of depression after starting propranolol and concluded that depression coming after the administration of propranolol was a real phenomenon.A number of studies have concluded that there appears to be no increased prevalence of depression in patients on beta-blockers. [24-29] Schleifer et al [24] evaluated for evidence of depression 190 patients who had sustained a myocardial infarction. The patients were interviewed 8 to 10 days after the infarct and again at 3 months. No antianginal or antihypertensive medication including beta-blockers was associated with an increase in depression. Using a psychiatric interview and psychologic assessments, Carney et al [25] evaluated 75 patients undergoing elective cardiac catheterization. One half of the patients in the study were receiving beta-blockers. Thirty-three percent of the patients who were not receiving beta-blockers met Diagnostic and Statistical Manual or Mental Disorders, ed 3 (DSM-III) criteria for depression, and 21 percent of the patients taking beta-blockers met criteria for depression.
In a study of depression in new users of antihypertensive medications in the Harvard Community Health Plan medication registry, the rates of depression were no higher in those taking beta-blockers than in those taking other antihypertensive medications. [27] Using the records of the Saskatchewan prescription drug plan, Thiessen et al [28] studied the rates of antidepressant prescriptions written after beta-blockers were prescribed and found that 6.4 percent of beta-blocker users received a prescription for an antidepressant within 30 days compared with 2.8 percent of the reference group. A similar study design by Hallas [30] showed no increase in antidepressant prescribing after patients received a beta-blocker.
A great deal of concern about the possibility of beta-blockers causing depression was generated by early case reports and subsequent case series. None of these reports evaluated the frequency of depression in a control group. Confounding the issue is the side effect of fatigue, which is frequently reported in patients on beta-blockers. [31] Patients might have depression incorrectly diagnosed if fatigue is the only depressive symptom. Depression occurring after major medical illness such as an myocardial infarction is common. As several studies have shown, [24,25] depression is common in patients with coronary artery disease regardless of what specific medications they are taking. Unfortunately, no large controlled prospective trials have addressed the issue of depression in patients taking beta-blockers. The beneficial effects of beta-blockers should not be overlooked in patients who have a history of depression, as the small possibility of a depressive effect caused by the beta-blocker might well be outweighed by its beneficial effect..."
poster:SalArmy4me
thread:70518
URL: http://www.dr-bob.org/babble/20010714/msgs/71021.html