Increased prescribing of antidepressants subsequent to beta-blocker therapy

Article Abstract:

An increased use of antidepressants in patients on beta-blocker therapy (for treating high blood pressure and other conditions) has been reported previously, and this study was undertaken to address some of the defects in previous research studies and to evaluate whether there is a connection between beta-blockers and depression. The Saskatchewan Prescription Drug Plan (SPDP) database, which includes 95 percent of the population of the province, was the source of data, yielding 672,863 individuals who fit the study criteria. Of the total group, 23,315 persons received prescriptions for beta-blockers and 20,522 individuals were prescribed antidepressants in 1984. Eight beta-blockers and 12 antidepressants were included in the study, and other drugs were also included to determine the concurrent use of antidepressants with medications other than beta-blockers. Patients taking beta-blockers were more likely to be using antidepressants than persons receiving other therapies. This increased risk was especially great for patients receiving propranolol, a specific beta-blocker. Other lipophilic (fat soluble) beta-blockers were no more likely than the hydrophilic (water soluble) beta-blockers to cause depressive symptoms, undermining the theory that fat-soluble beta-blockers enter the central nervous system in greater concentrations and therefore produce more side effects. Contrary to the expectation, the use of antidepressants decreased with age among patients taking propranolol, but this may have been caused by decreased sensitivity to the drug or less recognition of the side effects in the older age group. A problem with this study is that drugs, not diagnoses, were used to define groups of people, and drugs are used in a variety of ways. For persons on antidepressants, it is not known whether the doctor made a standard diagnosis of depression, or whether other side effects of beta-blockers, such as fatigue, sleep disturbances, and lethargy, were being treated with antidepressants. The incidence of depression may have been underestimated because only patients with symptoms severe enough to seek medical attention could be included. There was also no way to know whether the patients were taking the prescribed drugs, a common problem with antihypertensive medication because the patient typically feels worse when taking the medication than when not taking it. The authors suggest caution in prescribing beta-blocker therapy, and consideration of modifying beta-blocker therapy rather than adding an antidepressant if symptoms of depression occur. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Adrenergic beta blockers, Adrenergic beta-antagonists, Propranolol hydrochloride, Propranolol

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Depression, depressants, and antidepressants

Article Abstract:

Doctors frequently fail to diagnose depression, and even when they do diagnose it, they often do not treat it adequately. The cause of depression is not known, but both genetics and environment probably play a role. Triggers of depressive episodes include changes in body chemistry, stress, loss, and the winter "blues," or seasonal affective disorder (SAD). Drugs used to treat a variety of illnesses may also cause depression. New psychosocial approaches can help patients with mild forms of depression, and medications are safe and effective for most patients with serious, nonpsychotic depression. A combination of drugs and psychotherapy is effective for some. Some drugs and illnesses are more likely to cause depression than others, and antihypertensives (blood pressure medications), especially reserpine and propranolol, are one category suspected of being ''depressogenic.'' It is possible that propranolol is the only type of beta-blocker that causes depression. Thiessen and colleagues, in the November 1990 issue of the Archives of Internal Medicine, have reported that propranolol is associated with increased use of antidepressants, and conclude that patients taking this medication have a high incidence of depression. An interesting question arising from this study is why younger patients received more antidepressants. Physicians should watch for symptoms of depression generally, and particularly when there is a change in treatment. The potential cause should be addressed, and antidepressant therapy considered. Milder forms of depression can be treated by the primary physician or referred to a psychiatrist. Early diagnosis can help the patient to avoid great expense, as well as other serious problems resulting from depression. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, editorial

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Clinical implications of the competitive inhibition of the debrisoquin-metabolizing isozyme by quinidine

Article Abstract:

Doctors have long recognized that some patients experience more severe side effects to drugs than others. Recent evidence suggests that in some instances, this phenomenon may be due to inherited tendencies to metabolize certain substances poorly. This results in more active drug in the bloodstream, and less excretion of the drug and its byproducts. In Europe, approximately 10 percent of the population has been found to be poor metabolizers (PMs) of the blood pressure lowering drug debrisoquin. When subjects who are PMs receive debrisoquin, their blood pressures drop dramatically. The liver enzyme in which these PMs are deficient has been named CYP2D6, and this enzyme is also responsible for metabolizing other drugs similar to debrisoquin. Quinidine, a drug used to correct certain irregular heart rhythms, binds to CYP2D6 and causes people to become PMs of debrisoquin and other drugs that use the same enzyme. Thus, patients on quinidine can experience exaggerated side effects to drugs such as the blood pressure agents known as beta blockers and certain psychiatric drugs. Caution should be used in adding these drugs to the regimens of patients taking quinidine or those known to be PMs of debrisoquin. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drugs, Physiological aspects, Drug metabolism, Bioavailability, Quinidine

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