Research Does Not Support Worry that Beta Blockers Cause Depression, Fatigue and Sexual Dysfunction

There is no data to support the worry that beta blockers, prescribed following a heart attack to guard against future episodes, commonly cause depression, fatigue and sexual dysfunction, according to a study by Yale researchers published this week in the Journal of the American Medical Association.

Harlan Krumholz, M.D., associate professor of internal medicine and cardiology at Yale School of Medicine and senior investigator of the study, has long been concerned about the underutilization of beta blockers by physicians as a tool in preventing future heart attacks. A study by his group in 1995 showed that 50 percent of heart attack patients who could benefit from beta blockers were not being prescribed the medication. Krumholz said that figure today reportedly is as high as 75 percent.

He said he conducted the study to hopefully dispel some of the misconceptions about the medication that may contribute to the underutilization.

Beta blockers are any of a group of drugs widely used in the treatment of patients with heart disease and hypertension. The drugs, among them propranolol, naldolol and atenolol metoprolol, decrease the rate and force of heart contraction by blocking the beta-adrenegic receptors of the autonomic nervous system.

“For a long time there has been conventional wisdom that beta blockers are associated with substantial adverse non-cardiac symptoms,” Krumholz said. “But most of the conventional wisdom was anecdotal. There was no systematic review of this association.”

To determine whether beta blockers cause depression, fatigue and sexual dysfunction, the Yale group looked at 15 clinical trials involving more than 35,000 subjects who were prescribed beta blockers for the treatment of heart attack, heart failure or hypertension.

“What we found is there is no clear evidence that use of beta blockers causes depression,” Krumholz said. “There was a slight association between use of beta blockers and resulting fatigue and sexual dysfunction.” The risk of fatigue was the equivalent of one additional report for every 57 patients treated. The risk of sexual dysfunction was one additional report of sexual dysfunction for every 199 patients treated with beta blockers.

“We also found that these symptoms were common among patients taking placebo,” Krumholz said. “Therefore, given the survival benefit associated with beta blocker therapy for patients who have had a heart attack, concerns about the development of these adverse effects should not deter physicians and their patients from initiating long term treatment when indicated, although surveillance for adverse effects remains prudent.”

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