Abstract
Cardiac medications including β-blockers, cardiac glycosides, and antiarrhythmics have long been known to have CNS effects including alterations in mood, emotion state anxiety, and depression. While the predominant effects come from those with higher lipophilicity and when used at high doses, the evidence is actually quite mixed. At cardiac therapeutic doses, lipophilic β-blockers like propranolol have actually few CNS effects on mood. The effectiveness of β-blockers is established for relieving performance anxiety, but the actions involve more a peripheral relief of somatic symptoms rather than a central effect. By contrast the reduction in consolidation of aversive and stressful memory by propranolol appears to involve altering the functioning of the amygdala and hippocampus directly. While evidence suggests that β-blockers reduce aggressive behaviors associated with various psychological conditions such as schizophrenia, they are now used relatively rarely. Cardiac glycosides such as digoxin have been implicated in causing a variety of mental dysfunctions including depression, yet quality prospective trials are lacking and evidence is largely anecdotal. The difficulty is that the patients likely to receive either β-blockers or digoxin are often suffering heart failure which in itself causes mood alterations such as depression. The current review analyzes the evidence of mood-altering side effects for the various pharmacological agents used to treat cardiac disease.
References
Angrini, M., Leslie, J. C., & Shephard, R. A. (1998). Effects of propranolol, buspirone, pcpa, reserpine, and chlordiazepoxide on open-field behavior. Pharmacology Biochemistry and Behavior, 59(2), 387–397.
Applegate, W. B., Pressel, S., Wittes, J., Luhr, J., Shekelle, R. B., Camel, G. H., et al. (1994). Impact of the treatment of isolated systolic hypertension on behavioral variables. Results from the systolic hypertension in the elderly program. Archives of Internal Medicine, 154(19), 2154–2160.
Ashton, H., Millman, J., Telford, R., & Thompson, J. W. (1976). A comparison of some physiological and psychological effects of propranolol and diazepam in normal subjects. British Journal of Clinical Pharmacology, 3, 551–559.
Avorn, J., Everitt, D. E., & Weiss, S. (1986). Increased antidepressant use in patients prescribed beta-blockers. JAMA, 255(3), 357–360.
Binstok, G., Foster, L. G., & Mullane, J. F. (1984). Propranolol and the depression component of anxiety neurosis. Current Therapeutic Research, 35(3), 423–432.
Brantigan, C. O., Brantigan, T. A., & Joseph, N. (1982). Effect of beta blockade and beta stimulation on stage fright. American Journal of Medicine, 72(1), 88–94.
Brieden, T., Ujeyl, M., & Naber, D. (2002). Psychopharmacological treatment of aggression in schizophrenic patients. Pharmacopsychiatry, 35(3), 83–89.
Bright, R. A., & Everitt, D. E. (1992). Beta-blockers and depression. Evidence against an association. JAMA, 267(13), 1783–1787.
Cahill, L., & van Stegeren, A. (2003). Sex-related impairment of memory for emotional events with beta-adrenergic blockade. Neurobiology of Learning and Memory, 79(1), 81–88.
Cahill, L., Prins, B., Weber, M., & McGaugh, J. L. (1994). Beta-adrenergic activation and memory for emotional events. Nature, 371(6499), 702–704.
Carney, R. M., Rich, M. W., teVelde, A., Saini, J., Clark, K., & Freedland, K. E. (1987). Prevalence of major depressive disorder in patients receiving beta-blocker therapy versus other medications. American Journal of Medicine, 83(2), 223–226.
Carr, C. P., Martins, C. M., Stingel, A. M., Lemgruber, V. B., & Juruena, M. F. (2013). The role of early life stress in adult psychiatric disorders: A systematic review according to childhood trauma subtypes. Journal of Nervous and Mental Disease, 201(12), 1007–1020.
Celano, C. M., Freudenreich, O., Fernandez-Robles, C., Stern, T. A., Caro, M. A., & Huffman, J. C. (2011). Depressogenic effects of medications: A review. Dialogues in Clinical Neuroscience, 13(1), 109–125.
Charney, D. S., Menkes, D. B., & Heninger, G. R. (1981). Receptor sensitivity and the mechanism of action of antidepressant treatment. Implications for the etiology and therapy of depression. Archives of General Psychiatry, 38(10), 1160–1180.
Conant, J., Engler, R., Janowsky, D., Maisel, A., Gilpin, E., & LeWinter, M. (1989). Central nervous system side effects of [beta]-adrenergic blocking agents with high and low lipid solubility. Journal of Cardiovascular Pharmacology, 13(4), 656–661.
Cukor, J., Spitalnick, J., Difede, J., Rizzo, A., & Rothbaum, B. O. (2009). Emerging treatments for ptsd. Clinical Psychology Review, 29(8), 715–726.
de Kleine, R. A., Rothbaum, B. O., & van Minnen, A. (2013). Pharmacological enhancement of exposure-based treatment in ptsd: A qualitative review. European Journal Psychotraumatology, 4, 21626.
Dimsdale, J. E., Newton, R. P., & Joist, T. (1989). Neuropsychological side effects of beta-blockers. Archives of Internal Medicine, 149(3), 514–525.
Dunbar, S. B., Kimble, L. P., Jenkins, L. S., Hawthorne, M., Dudley, W., Slemmons, M., et al. (1999). Association of mood disturbance and arrhythmia events in patients after cardioverter defibrillator implantation. Depression and Anxiety, 9(4), 163–168.
Faigel, H. C. (1991). The effect of beta blockade on stress-induced cognitive dysfunction in adolescents. Clinical Pediatrics (Phila), 30(7), 441–445.
Fava, M. (1997). Psychopharmacologic treatment of pathologic aggression. The Psychiatric Clinics of North America, 20(2), 427–451.
Fisher, A. A., Davis, M., & Jeffery, I. (2002). Acute delirium induced by metoprolol. Cardiovascular Drugs and Therapy, 16(2), 161–165.
Fitzgerald, J. D. (1967). Propranolol-induced depression. British Medical Journal, 2(5548), 372–373.
Fleminger, S., Greenwood, R. J., & Oliver, D. L. (2006). Pharmacological management for agitation and aggression in people with acquired brain injury. Cochrane Database of Systematic Reviews, 4, CD003299.
Fletcher, A. E., Bulpitt, C. J., Hawkins, C. M., Havinga, T. K., ten Berge, B. S., May, J. F., et al. (1990). Quality of life on antihypertensive therapy: A randomized double-blind controlled trial of captopril and atenolol. Journal of Hypertension, 8(5), 463–466.
Fodor, J. G., Chockalingam, A., Drover, A., Fifield, F., & Pauls, C. J. (1987). A comparison of the side effects of atenolol and propranolol in the treatment of patients with hypertension. The Journal of Clinical Pharmacology, 27(11), 892–901.
Fraser, H. S., & Carr, A. C. (1976). Propranolol psychosis. British Journal of Psychiatry, 129, 508–509.
Frasure-Smith, N., Lesperance, F., & Talajic, M. (1993). Depression following myocardial infarction. Impact on 6-month survival. JAMA, 270(15), 1819–1825.
Frcka, G., & Lader, M. (1988). Psychotropic effects of repeated doses of enalapril, propranolol and atenolol in normal subjects. British Journal of Clinical Pharmacology, 25(1), 67–73.
Garakani, A., Mathew, S. J., & Charney, D. S. (2006). Neurobiology of anxiety disorders and implications for treatment. Mount Sinai Journal of Medicine, 73(7), 941–949.
Gerstman, B. B., Jolson, H. M., Bauer, M., Cho, P., Livingston, J. M., & Platt, R. (1996). The incidence of depression in new users of beta-blockers and selected antihypertensives. Journal of Clinical Epidemiology, 49(7), 809–815.
Glassman, A. H., Johnson, L. L., Giardina, E. G., Walsh, B. T., Roose, S. P., Cooper, T. B., et al. (1983). The use of imipramine in depressed patients with congestive heart failure. JAMA, 250(15), 1997–2001.
Glaubiger, G., & Lefkowitz, R. J. (1977). Elevated beta-adrenergic receptor number after chronic propranolol treatment. Biochemical and Biophysical Research Communications, 78(2), 720–725.
Goldstein, G., Materson, B. J., Cushman, W. C., Reda, D. J., Freis, E. D., Ramirez, E. A., et al. (1990). Treatment of hypertension in the elderly: Ii. Cognitive and behavioral function. Results of a department of veterans affairs cooperative study. Hypertension, 15(4), 361–369.
Granville-Grossman, K. L., & Turner, P. (1966). The effect of propranolol on anxiety. Lancet, 1(7441), 788–790.
Griffin, S. J., & Friedman, M. J. (1986). Depressive symptoms in propranolol users. Journal of Clinical Psychiatry, 47(9), 453–457.
Hallas, J. (1996). Evidence of depression provoked by cardiovascular medication: A prescription sequence symmetry analysis. Epidemiology, 7(5), 478–484.
Hartley, L. R., Ungapen, S., Davie, I., & Spencer, D. J. (1983). The effect of beta adrenergic blocking drugs on speakers’ performance and memory. British Journal of Psychiatry, 142, 512–517.
Haspel, T. (1995). Beta-blockers and the treatment of aggression. Harvard Review Psychiatry, 2(5), 274–281.
Hayes, P., & Schulz, S. (1987). Beta-blockers in anxiety disorders. Journal of Affective Disorders, 13(2), 119–130.
Head, A., Kendall, M. J., Ferner, R., & Eagles, C. (1996). Acute effects of beta blockade and exercise on mood and anxiety. British Journal of Sports Medicine, 30(3), 238–242.
Hirschmann, S., Dannon, P. N., Iancu, I., Dolberg, O. T., Zohar, J., & Grunhaus, L. (2000). Pindolol augmentation in patients with treatment-resistant panic disorder: A double-blind, placebo-controlled trial. Journal of Clinical Psychopharmacology, 20(5), 556–559.
Keller, S., & Frishman, W. H. (2003). Neuropsychiatric effects of cardiovascular drug therapy. Cardiology in Review, 11(2), 73–93.
Kelly, D. (1985). Beta-blockers in anxiety. Stress Medicine, 1(2), 143–152.
Kindt, M., Soeter, M., & Vervliet, B. (2009). Beyond extinction: Erasing human fear responses and preventing the return of fear. Nature Neuroscience, 12(3), 256–258.
Ko, D. T., Hebert, P. R., Coffey, C. S., Sedrakyan, A., Curtis, J. P., & Krumholz, H. M. (2002). Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction. JAMA, 288(3), 351–357.
Konstam, V., Moser, D. K., & De Jong, M. J. (2005). Depression and anxiety in heart failure. Journal of Cardiac Failure, 11(6), 455–463.
Kostis, J. B., Rosen, R. C., Cosgrove, N. M., Shindler, D. M., & Wilson, A. C. (1994). Nonpharmacologic therapy improves functional and emotional status in congestive heart failure. Chest, 106(4), 996–1001.
Lerer, B., Ebstein, R. P., & Belmaker, R. H. (1981). Subsensitivity of human beta-adrenergic adenylate cyclase after salbutamol treatment of depression. Psychopharmacology, 75(2), 169–172.
Liebowitz, M. R., Gorman, J. M., Fyer, A. J., & Klein, D. F. (1985). Social phobia. Review of a neglected anxiety disorder. Archives of General Psychiatry, 42(7), 729–736.
Lonergan, M. H., Olivera-Figueroa, L. A., Pitman, R. K., & Brunet, A. (2013). Propranolol’s effects on the consolidation and reconsolidation of long-term emotional memory in healthy participants: A meta-analysis. Journal of Psychiatry and Neuroscience, 38(4), 222–231.
Love, J. N., & Handler, J. A. (1995). Toxic psychosis: An unusual presentation of propranolol intoxication. American Journal of Emergency Medicine, 13(5), 536–537.
McGahan, D. J., Wojslaw, A., Prasad, V., & Blankenship, S. (1984). Propranolol-induced psychosis. Drug Intelligence & Clinical Pharmacy, 18(7–8), 601–603.
McGhee, L. L., Maani, C. V., Garza, T. H., Desocio, P. A., Gaylord, K. M., & Black, I. H. (2009). The effect of propranolol on posttraumatic stress disorder in burned service members. Journal of Burn Care & Research, 30(1), 92–97.
McNeil, G. N., Shaw, P. K., & Dock, D. S. (1982). Substitution of atenolol for propranolol in a case of propranolol-related depression. The American Journal of Psychiatry, 139(9), 1187–1188.
Middlemiss, D. N., Buxton, D. A., & Greenwood, D. T. (1981). Beta-adrenoceptor antagonists in psychiatry and neurology. Pharmacology and Therapeutics, 12(2), 419–437.
Myers, M. G., Lewis, P. J., Reid, J. L., & Dollery, C. T. (1975). Brain concentration of propranolol in relation to hypotensive effect in the rabbit with observations on brain propranolol levels in man. Journal of Pharmacol and Experimental Therapeutics, 192(2), 327–335.
Nader, K., Schafe, G. E., & Le Doux, J. E. (2000). Fear memories require protein synthesis in the amygdala for reconsolidation after retrieval. Nature, 406(6797), 722–726.
Neil-Dwyer, G., Bartlett, J., McAinsh, J., & Cruickshank, J. M. (1981). Beta-adrenoceptor blockers and the blood-brain barrier. British Journal of Clinical Pharmacology, 11(6), 549–553.
Oppenheim, G. (1983). Propranolol-induced depression: Mechanism and management. The Australian and New Zealand Journal of Psychiatry, 17(4), 400–402.
Papademetriou, V. (2009). Comparison of nebivolol monotherapy versus nebivolol in combination with other antihypertensive therapies for the treatment of hypertension. American Journal of Cardiology, 103(2), 273–278.
Parker, W. A. (1985). Propranolol-induced depression and psychosis. Clinical Pharmacy, 4(2), 214–218.
Patten, S. B., & Love, E. J. (1993). Can drugs cause depression? A review of the evidence. Journal of Psychiatry and Neuroscience, 18(3), 92–102.
Peskind, E. R., Tsuang, D. W., Bonner, L. T., Pascualy, M., Riekse, R. G., Snowden, M. B., et al. (2005). Propranolol for disruptive behaviors in nursing home residents with probable or possible alzheimer disease: A placebo-controlled study. Alzheimer Disease and Associated Disorders, 19(1), 23–28.
Petrie, W. M., Maffucci, R. J., & Woosley, R. L. (1982). Propranolol and depression. The American Journal of Psychiatry, 139(1), 92–94.
Pitman, R. K., Sanders, K. M., Zusman, R. M., Healy, A. R., Cheema, F., Lasko, N. B., et al. (2002). Pilot study of secondary prevention of posttraumatic stress disorder with propranolol. Biological Psychiatry, 51(2), 189–192.
Pozuelo, L., Tesar, G., Zhang, J., Penn, M., Franco, K., & Jiang, W. (2009). Depression and heart disease: What do we know, and where are we headed? Cleveland Clinic Journal of Medicine, 76(1), 59–70.
Ravaris, C. L., Friedman, M. J., Hauri, P. J., & McHugo, G. J. (1991). A controlled study of alprazolam and propranolol in panic-disordered and agoraphobic outpatients. Journal of Clinical Psychopharmacology, 11(6), 344–350.
Reist, C., Duffy, J. G., Fujimoto, K., & Cahill, L. (2001). Beta-adrenergic blockade and emotional memory in ptsd. International Journal of Neuropsychopharmacology, 4(4), 377–383.
Ried, L. D., McFarland, B. H., Johnson, R. E., & Brody, K. K. (1998). Β-blockers and depression: The more the murkier? Annals of Pharmacotherapy, 32(6), 699–708.
Rodriguez-Romaguera, J., Sotres-Bayon, F., Mueller, D., & Quirk, G. J. (2009). Systemic propranolol acts centrally to reduce conditioned fear in rats without impairing extinction. Biological Psychiatry, 35, 887–892.
Salem, S. A. M., & McDevitt, D. G. (1984). Central effects of single oral doses of propranolol in man. British Journal of Clinical Pharmacology, 17, 31–36.
Schleifer, S. J., Slater, W. R., Macari-Hinson, M. M., Coyle, D. A., Kahn, M., Zucker, H. D., et al. (1991). Digitalis and beta-blocking agents: Effects on depression following myocardial infarction. American Heart Journal, 121(5), 1397–1402.
Schneier, F. R. (2006). Clinical practice. Social anxiety disorder. New England Journal of Medicine, 355(10), 1029–1036.
Schwabe, L., Romer, S., Richter, S., Dockendorf, S., Bilak, B., & Schachinger, H. (2009). Stress effects on declarative memory retrieval are blocked by a beta-adrenoceptor antagonist in humans. Psychoneuroendocrinology, 34(3), 446–454.
Schwabe, L., Nader, K., Wolf, O. T., Beaudry, T., & Pruessner, J. C. (2012). Neural signature of reconsolidation impairments by propranolol in humans. Biological Psychiatry, 71(4), 380–386.
Sela, V. R., Roncon, C. M., Zangrossi, H., Jr., Graeff, F. G., & Audi, E. A. (2010). Pindolol potentiates the panicolytic effect of paroxetine in the elevated t-maze. Life Sciences, 87(13–14), 445–450.
Smith, H. (1938). Cerebral manifestations of digitalis intoxication. Mayo Clinic Proceedings, 13, 574–575.
Soeter, M., & Kindt, M. (2010). Dissociating response systems: Erasing fear from memory. Neurobiology of Learning and Memory, 94(1), 30–41.
Sorgi, P., Ratey, J., Knoedler, D., Arnold, W., & Cole, L. (1992). Depression during treatment with beta-blockers: Results from a double-blind placebo-controlled study. Journal of Neuropsychiatry and Clinical Neurosciences, 4(2), 187–189.
Steiner, S. S., Friedhoff, A. J., Wilson, B. L., Wecker, J. R., & Santo, J. P. (1990). Antihypertensive therapy and quality of life: A comparison of atenolol, captopril, enalapril and propranolol. Journal of Human Hypertension, 4(3), 217–225.
Stoudemire, A., Brown, J. T., Harris, R. T., Blessing-Feussner, C., Roberts, J. H., Nichols, J. C., et al. (1984). Propranolol and depression: A reevaluation based on a pilot clinical trial. Psychiatric Medicine, 2(2), 211–218.
Tawa, J., & Murphy, S. (2013). Psychopharmacological treatment for military posttraumatic stress disorder: An integrative review. Journal American Association Nurse Practitioner, 25(8), 419–423.
Taylor, E. A., Jefferson, D., Carroll, J. D., & Turner, P. (1981). Cerebrospinal fluid concentrations of propranolol, pindolol and atenolol in man: Evidence for central actions of beta-adrenoceptor antagonists. British Journal of Clinical Pharmacology, 12(4), 549–559.
Thiessen, B. Q., Wallace, S. M., Blackburn, J. L., Wilson, T. W., & Bergman, U. (1990). Increased prescribing of antidepressants subsequent to beta-blocker therapy. Archives of Internal Medicine, 150(11), 2286–2290.
Vaiva, G., Ducrocq, F., Jezequel, K., Averland, B., Lestavel, P., Brunet, A., et al. (2003). Immediate treatment with propranolol decreases posttraumatic stress disorder two months after trauma. Biological Psychiatry, 54(9), 947–949.
van Melle, J. P., & de Jonge, P. (2009). Beta-blocker use and the development of depression. American Journal of Cardiology, 103(9), 1331–1332.
van Melle, J. P., Verbeek, D. E. P., van den Berg, M. P., Ormel, J., van der Linde, M. R., & de Jonge, P. (2006). Beta-blockers and depression after myocardial infarction a multicenter prospective study. Journal of the American College of Cardiology, 48(11), 2209–2214.
Viadero, J. J., Wong, S. H., & White, W. B. (1983). Acute psychotic behavior associated with atenolol. The American Journal of Psychiatry, 140(10), 1382.
Volavka, J., Citrome, L., & Huertas, D. (2006). Update on the biological treatment of aggression. Actas Españolas de Psiquiatría, 34(2), 123–135.
Waal, H. J. (1967). Propranolol-induced depression. British Medical Journal, 2(5543), 50.
Walker, D. L., & Davis, M. (2002). Light-enhanced startle: Further pharmacological and behavioral characterization. Psychopharmacology, 159(3), 304–310.
Ward, F., Tharian, P., Roy, M., Deb, S., & Unwin, G. L. (2013). Efficacy of beta blockers in the management of problem behaviours in people with intellectual disabilities: A systematic review. Research in Developmental Disabilities, 34(12), 4293–4303.
Withering, W. (1785). An account of the foxglove and some of its medical uses; with practical remarks on the dropsy, and some other diseases. Birmingham: Swinney.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer Science+Business Media Singapore
About this entry
Cite this entry
Head, G.A. (2015). Impact of Cardiac Medications on Mood. In: Alvarenga, M., Byrne, D. (eds) Handbook of Psychocardiology. Springer, Singapore. https://doi.org/10.1007/978-981-4560-53-5_65-1
Download citation
DOI: https://doi.org/10.1007/978-981-4560-53-5_65-1
Received:
Accepted:
Published:
Publisher Name: Springer, Singapore
Online ISBN: 978-981-4560-53-5
eBook Packages: Springer Reference Behavioral Science and PsychologyReference Module Humanities and Social SciencesReference Module Business, Economics and Social Sciences