Do β-Blockers Cause Depression? Systematic Review and Meta-Analysis of Psychiatric Adverse Events During β-Blocker Therapy

beta-Blockers are important drugs in the treatment of cardiovascular diseases. They are suspected of inducing various psychiatric adverse events (PAEs), particularly depression, affecting cardiovascular morbidity and mortality. We performed a systematic search for double-blind, randomized controlled trials investigating beta-blockers to analyze the risk of PAEs or withdrawal of therapy due to PAEs. We extracted the frequencies of PAEs and rates of withdrawals and reviewed them to the number of exposed patients. For beta-blockers versus placebo or other active treatment, we calculated odds ratios for individual PAEs and withdrawal rates. We retrieved overall 285 eligible studies encompassing 53 533 patients. The risk of bias was judged to be high in 79% of the studies. Despite being the most frequently reported PAE with a total of 1600 cases, depression did not occur more commonly during beta-blockers than during placebo (odds ratio, 1.02 [95% CI, 0.83-1.25]). beta-Blocker use was also not associated with withdrawal for depression (odds ratio, 0.97 [95% CI, 0.51-1.84]). Similar results were obtained for comparisons against active agents. Among other PAEs, only unusual dreams, insomnia, and sleep disorder were possibly related to beta-blocker therapy. In conclusion, this analysis of large-scale data from double-blind, randomized controlled trials does not support an association between beta-blocker therapy and depression. Similarly, no effect for beta-blockers was found for other PAEs, with the possible exceptions of sleep-related disorders. Consequently, concerns about beta-blockers' impact on psychological health should not affect their use in clinical practice.

Automated summary

Analysis of large-scale data from double-blind, randomized controlled trials did not find an association between beta-blocker therapy and depression. Similarly, beta-blockers showed no effect on other psychiatric adverse events, except for a possible link with sleep-related disorders. Therefore, concerns about the impact of beta-blockers on mental health should not affect their clinical use.