Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.
J Clin Psychopharmacol. 2011 Feb;31(1):45-50. doi: 10.1097/JCP.0b013e31820482c4.
The hypothesis that β-blockers cause depression has been both confirmed and refuted in previous studies. However, in hardly any of these studies, depression was systematically and adequately assessed. The aim of this cohort study was to examine whether β-blockers, in general, highly lipid-soluble, nonselective, or serotonergic receptor-binding β-blockers, are associated with incident depression. Between 1993 and 2005, 5104 elderly persons were followed for incident depressions. Depressions were identified by regular interview and continuous monitoring of medical records. Cases were categorized as clinically relevant depressive symptoms or as depressive syndromes, the latter including Diagnostic and Statistical Manual of Mental Disorders-IV-defined depressive disorders. Pharmacies provided information on filled β-blockers. We used Cox regression with drug use as a time-dependent variable to analyze the data, adjusted for potential demographic covariates, activity of daily living, and (contra)indications for β-blockers. We found that use of β-blockers in general did not convey an increased risk of depressive symptoms (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.37-1.59) or depressive syndromes (HR, 0.99; 95% CI, 0.53-1.84). Highly lipid-soluble β-blockers, mostly propranolol in our study, were associated with depressive symptoms during the first 3 months of use (HR, 3.31; 95% CI, 1.03-10.6), but not with depressive syndromes. Nonselective or serotonergic receptor affinity was not associated with an increased risk of depressive symptoms or syndromes independent of high lipid solubility. We conclude that β-blockers in general do not convey an increased risk of depression. Lipophilic β-blockers are associated with an increased risk of depressive symptoms.
先前的研究既证实了β受体阻滞剂会导致抑郁这一假说，也对其进行了反驳。然而，在这些研究中几乎没有一个对抑郁进行了系统和充分的评估。本队列研究旨在检验β受体阻滞剂总体、高度脂溶性、非选择性或 5-羟色胺受体结合β受体阻滞剂是否与新发抑郁相关。1993 年至 2005 年，5104 名老年人随访新发抑郁情况。通过定期访谈和连续监测医疗记录来确定抑郁。病例分为有临床意义的抑郁症状或抑郁综合征，后者包括精神障碍诊断与统计手册第四版（DSM-IV）定义的抑郁障碍。药店提供β受体阻滞剂的使用信息。我们使用 Cox 回归，将药物使用作为一个时依变量，对数据进行分析，调整了潜在的人口统计学协变量、日常生活活动以及（禁忌）使用β受体阻滞剂的情况。我们发现，β受体阻滞剂总体使用与抑郁症状（危险比 [HR]，0.76；95%置信区间 [CI]，0.37-1.59）或抑郁综合征（HR，0.99；95% CI，0.53-1.84）的风险增加无关。在我们的研究中，高度脂溶性的β受体阻滞剂（主要是普萘洛尔）在使用的前 3 个月与抑郁症状相关（HR，3.31；95% CI，1.03-10.6），但与抑郁综合征无关。非选择性或 5-羟色胺受体亲和力与抑郁症状或综合征的风险增加无关，而与脂溶性无关。我们的结论是，β受体阻滞剂总体上不会增加抑郁的风险。亲脂性β受体阻滞剂与抑郁症状的风险增加有关。
