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There has been a long-standing concern that beta-blockers may induce or potentiate clinical depression and possibly other neuropsychiatric conditions,(2) although recent systematic reviews have attributed less significance to such an association.(3) Yet, from a clinical practice perspective, and regardless of the limitations of my N=1 experiences, I am convinced that the association between beta-blocker use and depression and other neuropsychiatric adverse events is real. I have witnessed this in something as straightforward as the administration of propranolol for migraine prophylaxis. Similar effects can also be seen with topical beta-blocker applications.(4) Both the short-term and long-term use of beta-blockers has been associated with depression.
This adverse effect has been associated with the lipophilicity or selectivity of a given beta-blocker, implying that different beta blockers may vary in the frequency of adverse events. Propranolol and timolol have attracted concern historically. Therefore, the combination of all beta-blockers together, as is often done in meta-analyses, may only muddy the waters. As has recently been stated, we need to continue with an open mind.(5) Given the potential for psychiatric co-morbidity, especially depression, the consumption of beta-blockers among patients with stimulant use should continue to attract careful attention and the beta-blocker should be prescribed for as short a period as possible.
Competing Interests: None declared.References
- 1. McKetin R, Leung J, Stockings E, et al. Mental health outcomes associated with the use of amphetamines: a systematic review and meta-analysis. EClinicalMedicine 2019;16:81-97.
- 2. Ried LD, McFarland BH, Johnson RE, Brody KK. Beta-blockers and depression: the more the murkier? Ann Pharmcother 1998;32(6):699-708.
- 3. Riemer TG, Villagomez Fuentes LE, Algharably EAE, et al. Do ß-blockers cause depression? Systematic review and meta-analysis of psychiatric adverse events during ß-blocker therapy. Hypertension 2021;77(5):1539-48.
- 4. Cimolai N. Neuropsychiatric adverse events from topical ophthalmic timolol. Clin Med Res 2019;17(3-4):90-6.
- 5. Andrade C. ß-blockers and the risk of new-onset depression : meta-analysis reassures, but the jury is still out. J Clin Psychiatry 2021 ;82(3) :21f14095.