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Author Topic: Beta Blocker least likely to cause Depression?  (Read 229 times)

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Offline Andrew90

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Beta Blocker least likely to cause Depression?
« on: May 06, 2014, 06:40:03 PM »
Hey guys,

I'm wondering if you guys might have any experience or advice on beta blockers. I'm weighing the decision to replace my daily dosing of guanfacine with a beta blocker, mainly because I have health anxiety fears and guanfacine isn't medically recommended in a combination with mirtazapine. I'm giving the Remeron a 2nd try (after having gained a few pounds the first time on it), and I am noticing that it is helping both my anxiety and depression. However, if you go to any drug-interactions website, they will list those two drugs as having a potentially dangerous hypertensive interaction...my psychiatrist has told me it's an unlikely circumstance given that I'm young and have an otherwise healthy BP range, and that it's more or less uncommonly seen empirically in the medical profession. However, I have a difficult time merely realizing that this interaction exists, because I dwell on it. Ultimately, this potential for an interaction is detracting from the psychological therapeutic potential of these medications.

I am not yet throwing my hands up on the guanfacine (Tenex), but I have an appt. with my psychiatrist later this week and I would just like to do some research on some alternative options. Keep in mind, I'm currently on an anti-hypertensive med because for me it helps with the source of my anxiety, which is very much related to the involuntary physiological sensations (higher HR, BP, etc.) that are accompanied by anxious moments.

I suppose what I'm asking is which beta blockers have less CNS side effects, particularly the ones which do not cross the Blood Brain Barrier?
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Offline insights

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Re: Beta Blocker least likely to cause Depression?
« Reply #1 on: May 06, 2014, 08:50:40 PM »
I suppose what I'm asking is which beta blockers have less CNS side effects, particularly the ones which do not cross the Blood Brain Barrier?

The lipid soluble beta-blockers which do penetrate into the brain are relatively benign. But if this is still a concern then sure, the water soluble ones which can't get through the BBB are an alternative. However, be aware that while the incidence of depression is much less with the hydrophilic ones, it isn't zero. Depression is still a listed side-effect for them too.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline Andrew90

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Re: Beta Blocker least likely to cause Depression?
« Reply #2 on: May 20, 2014, 06:58:57 PM »
Brief update: Recently I've been having panic attacks while exercising (doing only mild cardio), which has been really bothering me because I am now fearful of exercise and am avoiding it. The only way around this for me has been to take a xanax before I exercise, which does the trick, but I'm not pleased with the idea of having to take a benzo every time I am to exercise.

I am seeing my pdoc next week, and I am thinking of adding a beta blocker to use before I exercise, as this will take away some of that extra adrenaline that has been leading to my panic. I did some reading up online and asked a friend of mind who is a pharmacist, and the general consensus seems to be that propranolol is a good option to try, due to the fact that it has very flexible dosing options and has an established safety profile (although virtually all BB's do from what I understand).

Do you guys think that, in the aims of alleviating my panic attacks during exercise, it might be worth trying a low dose of propranolol (Inderal) at somewhere like 10 or 20 mg? If I decide to try that, I may just wean off of the guanfacine entirely and stick with the propranolol for daily use. The propranolol is also appealing to me because it may help to lessen the PVC's that I get (a few noticeable ones I get most days), although I am aware of the potential side effects (depression, fatigue, etc)...but a low dose is less likely to provoke such side effects, I reckon?
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Offline insights

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Re: Beta Blocker least likely to cause Depression?
« Reply #3 on: May 20, 2014, 08:24:57 PM »
I am aware of the potential side effects (depression, fatigue, etc)...but a low dose is less likely to provoke such side effects, I reckon?

In theory, yes. But the only way to know is to try it, unfortunately.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline Andrew90

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Re: Beta Blocker least likely to cause Depression?
« Reply #4 on: May 20, 2014, 09:36:29 PM »
One other question that's been tugging at me - what about verapamil? Studies seem to indicate that it actually has some anti-depressant effect, albeit mildly. At the least, it isn't associated with the depression that beta blockers more commonly have as a side effect. Of course, each person will react differently. But it's something I'm glad to have dug up.

Moreover, it has been shown to moderately effective for panic. This drug seems like a wiser choice, given that it isn't associated with as many adverse psychotropic effects as the common beta blockers. But I know very little. And like you said, the only way to know is to try it.

I'll bring this up with my psychiatrist.

Articles I found:

http://www.ncbi.nlm.nih.gov/pubmed/19212940

http://www.docguide.com/verapamil-sr-has-more-favorable-impact-mood-atenolol-hypertensive-patients-presented-ash-hyp

http://www.ncbi.nlm.nih.gov/pubmed/2450479
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Offline insights

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Re: Beta Blocker least likely to cause Depression?
« Reply #5 on: May 21, 2014, 12:53:26 AM »
what about verapamil? Studies seem to indicate that it actually has some anti-depressant effect, albeit mildly.

I'd take them with a grain of salt. There's at least one study showing it can trigger depression too. Unfortunately, it's not online. I can see why it might have a mild anti anxiety effect, but not an anti depressive one.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

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