Abstract and Introduction

Abstract

Objectives: The purpose of this research was to explore the prospective relationship between the use of beta-blockers and depression in myocardial infarction (MI) patients.
Background: Beta-blocker use has been reported to be associated with the development of depression, but the methodological quality of studies in this field is weak.
Methods: In a multicenter study, MI patients (n =127 non-beta-blocker users and n = 254 beta-blocker users) were assessed for depressive symptoms (using the Beck Depression Inventory [BDI] at baseline and t = 3, 6, and 12 months post-MI) and International Classification of Diseases-10 depressive disorder (Composite International Diagnostic Interview). Patients were matched using the frequency matching procedure according to age, gender, hospital of admission, presence of baseline depressive symptoms, and left ventricular function.
Results: No significant differences were found between non-beta-blocker users and beta-blocker users on the presence of depressive symptoms (p > 0.10 at any of the time points) or depressive disorder (p = 0.86). Controlling for confounders did not alter these findings. A trend toward increasing BDI scores was seen in patients with long-term use of beta-blockers and patients with higher beta-blocker dose.
Conclusions: In post-MI patients, prescription of beta-blockers is not associated with an increase in depressive symptoms or depressive disorders in the first year after MI. However, long-term and high-dosage effects cannot be ruled out.

Introduction

Beta-blockers are among the most prescribed drugs in the world. They are registered for a wide range of indications including hypertension, angina pectoris, arrhythmias, heart failure, and as secondary prevention after myocardial infarction (MI). They have proven benefits in decreasing morbidity as well as mortality.^[1] In MI patients, beta-blockers have shown to reduce mortality by 23%.^[2]

However, despite these beneficial effects, persistent concerns about adverse effects of beta-blockers have resulted in reluctance among clinicians in prescribing these drugs.^[3] Concerns especially exist about neuropsychological side effects, since Waal,^[4] as early as 1967, reported about a conspicuously high incidence of depression among a group of hypertensive patients using propanolol as antiarrhythmic therapy. It was assumed that particularly the more lipophylic beta-blockers, which can cross the blood-brain barrier more readily, are able to cause depression.^[5]

Subsequent studies were limited by small sample size,^[6-10] study design (e.g., cross-sectional [11], not prospective), the use of unvalidated or surrogate measures of depression,^[11-17] or the lack of appropriate baseline depression assessment.^[18] In the present study, we have tried to overcome these limitations and investigated the association between beta-blocker use and depression in a large, prospective study using standardized measures of depressive symptoms and depressive disorder. Given the strong indication for beta-blockers in post-MI patients and the profound association between post-MI depression and impaired cardiovascular prognosis,^[19] we decided to confine our study to MI patients.