Beta-blockers may increase risk of depression in heart attack survivors without heart failure

Beta blockers have long been the go-to for survivors. heart attackmay not be as essential or safe for all patients as previously believed.

A recent study conducted in Sweden suggests that these drugs may increase the risk of depression in heart attack survivors who continue to have normal heart pumping function.¹

“At the same time, beta-blockers have no survival benefit for this group of patients,” study lead author Philip Reisner, a doctoral student in cardiac psychology at Uppsala University, said in the paper. news release.²

As part of the REDUCE-AMI trial, this study european heart journal Shedding light on decades of cardiology practice.¹ Historically, most patients who have had a heart attack have been prescribed beta-blockers to reduce the chance of another heart attack, and these drugs are usually taken for life.³ However, among people who did not develop heart failure after a heart attack, long-term use of beta-blockers was associated with increased rates of depression.¹

“This effect may be particularly pronounced among people who have previously used beta-blockers,” the study authors wrote. “Given that clinical controversy remains regarding initiation and discontinuation of beta-blockers after AMI, [acute myocardial infarction]The potential risk of the small increase in depressive symptoms found in our study should be considered. ”

Beta-blockers have long been the go-to for heart attack survivors. |Image credit: JU.STOCKER – Stock.adobe.com

The study included more than 800 heart attack survivors without heart failure, half of whom were prescribed beta-blockers and half who were not. Patients in the beta-blocker group received either metoprolol or bisoprolol during hospitalization and were prescribed these drugs to continue after discharge. Doctors were advised to prescribe a daily dose of at least 100 mg for metoprolol and 5 mg for bisoprolol. The study tracked psychological outcomes over five years using the Hospital Anxiety and Depression Scale.

Results showed that patients taking beta-blockers had increased symptoms of depression, with 14% of enrolled patients having possible depression at baseline. At the first follow-up, 6 to 10 weeks after admission, these patients had an effect size of 0.48 (95% CI, 0.09 to 0.86; 95% CI, 0.09 to 0.86; P = .015). At the second follow-up, 12 to 14 months later, the effect of depression persisted, with an effect size of 0.41 (95% CI, 0.01 to 0.81; 95% CI, 0.01 to 0.81). P = .047).

The study also looked at the effects of treatment on anxiety, but the researchers found no apparent change in 27% of patients with anxiety symptoms at baseline.

One proposed explanation for the increase in depressive symptoms has to do with interactions between treatments and neurotransmitters, which may influence the autonomic nervous system based on properties such as lipid solubility and cardioselectivity. There is a gender. Additionally, beta-blockers can reduce patients' participation in pleasurable activities and cause symptoms of anhedonia, a major depressive feature as measured by the Hospital Anxiety and Depression Scale.

Previous research has suggested a link between these drugs and mood disorders such as depression, insomnia, and nightmares. New findings further emphasize these concerns and suggest that the risk of depression may be dose-dependent. Specifically, patients who were already taking beta-blockers before participating in the study had an even greater increase in depressive symptoms, pointing to the possibility of cumulative effects over time.

“Previously, most doctors also gave beta-blockers to patients without heart failure, but the evidence to support doing so is no longer as strong, so this should be reconsidered,” Reissner said. he added.² “Some of these patients may be considered to be at higher risk for depression. If the drug doesn't make a difference in the heart, then they are taking the drug unnecessarily and may be at higher risk for depression.” You're at risk of getting sick.”

The main limitation of this study is that measurements were taken after treatment assignment, which may introduce baseline bias.¹ Selection bias may also have occurred because some eligible patients were excluded, and the sample was generally healthier than the typical heart attack population. Additionally, the use of hospital anxiety and depression scales limits assessment to specific depression and anxiety symptoms, potentially missing broader psychological effects.

References

1. Reisner P, Mars K, Humphries S, et al. Short- and long-term effects of beta-blockers on symptoms of anxiety and depression in patients with myocardial infarction and preserved left ventricular function: a prespecified quality of life substudy from the REDUCE-AMI trial. Euroheart J Acute Cardiovascular Care. Published online October 3, 2024. doi:10.1093/ehjacc/zuae112
2. Patients can be unnecessarily depressed by common heart medications. News release. Uppsala University. November 11, 2024. Accessed November 12, 2024. https://www.uu.se/en/press/press-releases/2024/2024-11-11-patients-may-become-unnecessarily-depressed-by-common – Heart medicine
3. See: What are beta blockers? How do they work in the body? British Heart Foundation. Accessed November 12, 2024. https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/drug-cabinet/beta-blockers