Beta-Blockers Linked to Depression for Some Heart Attack Patients

Commonly prescribed beta-blockers may increase the risk of depression for some patients who have had heart attacks, but also have a normal heart pumping ability, new research from Uppsala University suggests.

The study, published in the European Heart Journal, proposes the drugs are likely not needed for this sub-group of patients.

Potential side effects for commonly prescribed drugs

Many patients are prescribed beta-blockers after experiencing a heart attack. The drugs work by blocking the effects of adrenaline on the heart to slow heart rate and reduce blood pressure, decreasing the heart’s demand for oxygen. This helps to prevent further stress on the heart in patients who have had a heart attack, lowers the risk of additional attacks and may improve overall survival.

However, a study in Sweden published earlier this year suggested that patients who still had good heart pumping ability after a heart attack (i.e., preserved left ventricular ejection fraction ≥ 50%) and who took long-term beta-blockers were not protected from new heart attacks or death.

Now, the latest study from the Uppsala researchers suggests the drugs have the potential to increase the risk of depression.

“Since the conception of beta-blockers there have been reports of sleep disturbances, nightmares and depression as side effects,” the study’s lead author, Philip Leissner, told Technology Networks. “Some studies have investigated this, but only using selective reporting (depending on patients to report when they notice symptoms) or only using observational data which is less robust for making causal interpretations.”

Leissner, a doctoral student in cardiac psychology at Uppsala University in Sweden, investigated this potential link, hypothesizing that patients taking beta-blockers would become more depressed.

Small increases in depression risk for some patients

Leissner’s sub-study, which enrolled over 800 patients from 2018 to 2023, looked at people who had had a heart attack but did not have heart failure.

Half of the enrolled patients received beta-blockers while the other half did not; approximately 100 patients had been taking beta-blockers before the start of the study.

The participants took a questionnaire – the Hospital Anxiety and Depression Scale – to measure anxiety and depression symptoms at 3 timepoints: first during their hospitalization for a heart attack then again at 6–10 weeks and 12–14 months.

The analysis revealed that those who received beta-blockers had slightly higher levels of depression compared to those who didn’t, though there was no difference in symptoms of anxiety.

“Patients randomized to beta-blockers did report higher levels of depression. However, in the group as a whole these differences were quite small,” said Leissner.

Patients who had been taking beta-blockers prior to the study also reported more severe depression symptoms.

“When we investigated specific subgroups, we found that those who [were already taking] beta-blockers before entering the study had larger differences, i.e. those who stopped taking them had lower depression ratings than those who continued, and this difference was larger than for the group as a whole,” Leissner explained.

“It is unclear why those who had been [taking] beta-blockers before would be more affected, but perhaps because they are sicker, they are more vulnerable,” he elaborated.

There were also some limitations to the study, however, which Leissner explains: “It was an open-label study design, meaning that patients knew what medication they were [taking]. That can always be an issue when studying psychological outcomes, as they can be affected by placebo and expectancy effects.”

Leissner has no immediate plans to follow up on this topic but explained that confirming the findings in this subgroup with a larger sample size would be of interest, as the small sample size made it “more exploratory rather than definitive.” Additionally, he recommends investigating different dosages and repeating the study using a placebo instead of an open-label design.

Reference: Leissner 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 pre-specified quality of life sub-study from the REDUCE-AMI trial. EHJ-ACVC. 2024:zuae112. doi: 10.1093/ehjacc/zuae112

About the interviewee:

Philip Leissner is a PhD candidate in cardiac psychology at Uppsala University. He holds a master’s degree in psychology from Umeå University and acquired his psychologist license in 2020, spending two years of clinical work in primary care. His research focuses on the connections between mortality, mental health, modifiable risk factors and behavioral interventions in patients with cardiovascular disease.