A new study, published this month in the journal Hypertension, analyzed hospital records from 144,066 patients in the UK over a 5-year follow-up period. The researchers found that the different classes of antihypertensive medications were associated with varying risk of developing depression and bipolar disorder. β-blockers and calcium antagonists were correlated with increased risk, while angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were actually associated with decreased risk. Being prescribed no antihypertensive medication or taking thiazide diuretics was associated with medium risk.
Antihypertensive medications are commonly prescribed to treat high blood pressure. The researchers theorized that brain systems such as L-type calcium channels could partially explain the increased risk of those taking β-blockers and calcium antagonists, as recent studies have implicated these brain systems in mood disorders. Likewise, the decreased risk of those taking angiotensin medications may be due in part to the renin–angiotensin system. This brain system has been implicated in pro-inflammatory processes that have been theorized to be involved in the development of mood disorders.
Of the 144,066 patients followed by this study, 299 of them (0.2%) were hospitalized for a mood disorder. While this may appear to be a low percentage, the relative increase in risk was striking: those taking β-blockers and calcium antagonists were twice as likely to develop a mood disorder as those taking angiotensin medications.
β-blockers have been associated with the development of depression, fatigue, and sexual dysfunction since the late 1960s. However, more recently, researchers have also cautioned that these cases appear to be relatively rare in the published trials of the drug, and tend to emphasize the benefits of β-blockers in the treatment of hypertension and other cardiac diseases. The results of the current study—a 100% increase in the likelihood of mood disorders for those taking β-blockers—mirror the concerns of previous researchers that these medications may lead to serious mental health consequences.
As this study examined only hospital data, the researchers could not identify the presence of less severe mood disorders that did not require hospitalization. Thus, less severe depression may be increased even more by β-blockers and calcium antagonists. The authors state that future research should examine this possibility in randomized controlled trials in order to gain a clearer picture of these outcomes.
Particularly given the ubiquity of prescriptions for antihypertensive medications, this study suggests that doctors should carefully consider which particular class of antihypertensive is indicated for each patient. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are associated with the least likelihood of developing depressive symptoms. However, these particular drugs may not be indicated for all situations. If β-blockers and calcium antagonists are found to be the appropriate medication for treating cardiac health, care must be taken to assess for the development of mood symptoms as side effects throughout the course of treatment.
Boal, A. H., Smith, D. J., McCallum, L., Muir, S., Touyz, R. M., Dominiczak, A. F., & Padmanabhan, S. (2016). Monotherapy with major antihypertensive drug classes and risk of hospital admissions for mood disorders. Hypertension, 68(5), 1132-1138. http://dx.doi.org/10.1161/HYPERTENSIONAHA.116.08188 (Abstract)
Another little-publicized and sometimes denied fact is that getting off some beta blockers can bring on crippling anxiety and even panic attacks. People use strong terms to describe what it’s like, with “hell” and “horrible” among the more popular.
Naturally, it’s been established that beta blockers are not worthwhile in the treatment of hypertension, and there are strong suggestions that treating hypertension, which is a predictor of cardiovascular diseases in the way ldl is a predictor, is more lethal than not treating it. This study was probably a headache ofr drug makers. It was done in Japan and included people in 6 levels of hypertension. It wasn’t a matter of those with the highest levels of hypertension being the most likely to be treated, with the hypertension rather than the treatment explaining the relatively high rates of death due to heart attack, stroke, etc. Blood pressure was linearly related to death in the untreated group, as we’ve been told, but being treated for it at any level of hypertension increased the odds of dying from cardiovascular disease, heart failure, and stroke.
Cardiovascular risk with and without antihypertensive drug treatment in the Japanese general population: participant-level meta-analysis.
“The risks of cardiovascular mortality were ≈1.5-fold high in participants under antihypertensive medication.” (No beating around the bush.)
“More attention should be paid to the residual cardiovascular risks in treated patients.” (“Residual” is a nice word.)
I was on a moderate dose of Coreg for just a few days for what turned out to be white coat hypertension. Even getting off the drug after not being on it for too long was not easy. I can’t imagine someone getting off it after being on the medication long term.
And by the way, it was the drug from h-ll. My exercise stamina was reduced by 50% and I definitely had depression that disappeared once I was off the drug.
I’ve read people’s comments about discontinuation on medical forums. They talk about atenolol withdrawal triggering panic attacks, agoraphobia, and anxiety so bad that people think they’ll die of it. What was it like getting off coreg?
OMG BL, I was only on it for a few days at a moderate dose and still felt like it was the drug from h-ll. There is no doubt in my mind that if I had been on it long term, the WD issues would have been horrible.
Are you currently on it?
No, but an elderly relative was on a beta-blocker called Atenolol at a very high dose for someone in her 80s who weighs 110 lbs. It was accidentally under-dosed when she was in a hospital for nothing. (Or, to fill empty beds and empty hospital bank account.) A nurse at the hospital called her pharmacy to find out what pills she was taking, and somehow, recorded 50 mg/day when the real dose was 150 mg/day.
She had been admitted “for observation” (of the hospital’s bottom line?) after going there for unnecessary sutures for a 1.5 cm laceration. It had had stopped bleeding before she was transported. (She had been involuntarily transported over her retired-surgeon husband’s objection by the for-profit company our city contracts for “paramedic” services, and how they got to the scene is a story in itself. It wasn’t her or her husband’s wish.) Interestingly, in the hospital records, the laceration became a 2 cm laceration between Day 1 and Day 3, despite not changing in actual length. Someone must have realized what a cluster-eff they’d inflicted on her and tried to create something like a justification for it.)
Because she had “inexplicably” fallen, she was subject to every test or scan imaginable, ultrasound scan for blood clots, brain CT-scan, EKG, x-rays, all with negative findings. The fall was easily explained by the chronic overdose of Atenolol, which sloppy nursing or sloppy pharmacy communication disguised as a normal (though still potentially problematic) dose.
I believe she got no Atenolol on the afternoon and evening of Day 1, but should have got 50mg at both times. She got none or 25 mg on the morning of Day 2. By 9:00 she was freaking out in a state of panic and terror and was tackled, jabbed with Haldol, and put in restraints.
It was a year ago and she’s still a changed, damaged, ruined human being as a consequence. The idiot nurses and doctors had caused withdrawal and as usual, blamed aberrant behavior on the patient, imputing it to psychiatric causes or voluntary behavior when the cause was physical and was their fault.
The upside is that she completely discontinued the drug afterwards, and hasn’t fallen once since then (12 months). Before that she was falling at least once every other month, luckily breaking some ribs and a vertebrae (i.e., her back) but not a hip, through all those collapses onto concrete and tiled floors. She’d been on Atenolol for at least 2 years. I found a flyer in her files, from AARP, which handles her Part D Medicare. It suggested switching to Atenolol because they were withdrawing coverage for a more expensive antihypertensive they were going to stop covering. (I forget which one it was).
I had no idea there was a beta-blocker withdrawal syndrome, but Dr. Google has opened my eyes with comments like these on various medical forums, all regarding Atenolol:
…went through enough terror with just that short time.
…my life and my blood pressure have not been the same since.
…great amounts of panic-anxiety
…full fledge [sic] panic attacks
…could not leave my house because of the bad anxiety and panic attacks
…times when I thought I was going to die
…felt like someone was continually injecting adreneline [sic]
…horrible anxiety attacks and very bad fatigue.
I’m glad you got off Coreg quickly. Was it real Coreg, or a generic? here are some horror stories about the generic…
And if it was for hypertension, the prescription would be questionable in the first place.
OMG BL, what a horrific situation regarding your elderly relative. I am glad she was able to discontinue Atenolol after going through a hellish experience with it.
I was on the generic form of Coreg. I had no idea about beta blocker syndrome until I started this med and was reading about side effects. If god forbid, I need a high blood pressure med in the future, I will refuse any BB’s.
There’s one antihypertensive that has improved memory test scores by two points out of ten, which is a lot, in very old people with hypertension, Losartan. My mother became noticeably sharper when she started taking it. It was about 8 months after the ordeal, and she began to recover. She could remember topics from one day to the next for the first time since the ordeal, and she talked about the kind of topics she had talked about all her life. Unfortunately, she finally went to a neurologist at her polydrugger’s request, and that moron started her on that accursed Aricept. I didn’t know until it was too late. I live two hours away…Neither doc had any idea how well she was doing since she started on Losartan. Her doc told the neuro ninny she had Alzheimer’s (which I think is false; this all began on a beta blocker right before the hospital ordeal). The idiot neurologist had no interest or expertise in geriatrics. So he writes a prescription for a toxic nocebo.
Damned if the next time I visited, my mom wasn’t on the floor in her underwear, having spent the night there with some pillows and blankets. She wouldn’t let my dad help her up.
All I could manage was to gently pull the blanket she was on towards the bathroom so she could put herself put back together. As I pulled, she cried out in terror, “NO! I’m going to fall! I’m falling!” and screamed a few times. Moving along the floor had invoked a hallucinatory experience of falling off a cliff or a building. It was horrifying to see my mother in such a state of terror, whether justifed at the moment or not. She was living whatever it was she was dreaming with her eyes wide open.
I could go on, but you get the point. Gotta love those MDs, the stupidest and most lethal people in the country. (Not exaggerating.)