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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by dave_fox on October 10, 2001, at 19:05:31
I have herad that some blood pressure meds can worsen depression. I see to recall that the beta-blockers were one group of BP med which did this.
Can anyone here tell me which groups of BP meds may worsen depression.
ALso any information on the degree of this worsening (effect at normal does of the BP) would be much appreciated.
Thank you.
Dave
Posted by Elizabeth on October 11, 2001, at 11:36:59
In reply to Blood pressure meds which can worsen depression?, posted by dave_fox on October 10, 2001, at 19:05:31
It's thought that beta blockers can worsen depression; however, clinical studies have been confounded by the fact that people with cardiovascular disease (the ones who would be taking beta blockers) are more likely to be depressed than the population in general. I think that some people probably do become more depressed on beta blockers, but it's a lot less common than it appears to be. Cardioselective beta blockers (like atenolol) are probably safest if you're still concerned, though.
I think that calcium channel blockers can cause or exacerbate depression. ACE inhibitors are the antihypertensive meds that are thought to be best for people with a history of depression.
A problem with treating hypertension is that when you add a drug, your cardiovascular system attempts to compensate for the effects of the drug. So often, more than one different type of drug may be used.
BTW I have a history of very severe depression (and a family history that's loaded with depression and related conditions), and I often take propranolol for tremor without any problem. So beta blockers are not necessarily bad for everyone. (OTOH, I don't take it every day like people with hypertension would have to).
-elizabeth
Posted by dave_fox on October 11, 2001, at 15:12:48
In reply to Re: Blood pressure meds which can worsen depression? » dave_fox, posted by Elizabeth on October 11, 2001, at 11:36:59
Elisabeth, thanks for your reply.
I had been wary of starting with beta-blockers for my blood pressure because I heard somewhere that they can cause depression. However Psychopharm Nut's cutting suggests that this may not be the case.
My doc wanted to start me on beta-blockers or thiazide diuretics for my blood pressure. I had heard the thiazide diuretics can adversely affect men sexually so I ruled them out and I had heard that beta blockers can affect mood so I ruled them out.
We have started on an ACE-inhibitor but with no good results yet. I was wondering if I had been too paranoid in ruling out the beta-blockers. I am now thinking that maybe the depressive side effects of beta blockers are so very rare as to be almost insignificant excet for special cases.
The newer classes of BP meds (alpha blockers and AA) are rather too expensive to try just yet (this is the UK here), so I supect that the calcium channel blockers will be next for me. Do you have any more info on the depressive effects of these meds which you mention?
------
I am sure that depression and blood pressure affect such huge numbers of people that there really must be a study somewhere which seeks to address exactly these sorts of questions.
However I can't find any such thing! Maybe "Psychopharm Nut" has more info about the paper he had quoted from.
Dave
Posted by Elizabeth on October 12, 2001, at 10:29:27
In reply to Re: Blood pressure meds which can worsen depression?, posted by dave_fox on October 11, 2001, at 15:12:48
> Elisabeth, thanks for your reply.
You're welcome. (It's "Elizabeth," with a "z," BTW. :-) )
> I had been wary of starting with beta-blockers for my blood pressure because I heard somewhere that they can cause depression. However Psychopharm Nut's cutting suggests that this may not be the case.
I think that it's *not* nearly as common a phenomenon as it used to be, although it may happen sometimes. I certainly wouldn't refuse to try beta blockers based on fears of worsened depression if I thought they could help me. I take a low dose of propranolol (10-20 mg as needed), though, and the risk may be greater with the higher doses typically used for hypertension.
> My doc wanted to start me on beta-blockers or thiazide diuretics for my blood pressure. I had heard the thiazide diuretics can adversely affect men sexually so I ruled them out and I had heard that beta blockers can affect mood so I ruled them out.
I wouldn't rule either of these out -- give them a try, and see whether they cause any problems for *you*. You can see what your doctor has to say about the potential side effects.
> We have started on an ACE-inhibitor but with no good results yet.
Which one? Like I said, sometimes you need multiple meds to treat hypertension. It can be really complicated.
> I was wondering if I had been too paranoid in ruling out the beta-blockers. I am now thinking that maybe the depressive side effects of beta blockers are so very rare as to be almost insignificant excet for special cases.
I would like to see a clinical trial using a beta blocker in people with no cardiovascular disease and see if the drug causes depression in these people.
> The newer classes of BP meds (alpha blockers and AA) are rather too expensive to try just yet (this is the UK here), so I supect that the calcium channel blockers will be next for me.
What alpha antagonists are they using there? Phentolamine?
> Do you have any more info on the depressive effects of these meds which you mention?
Nope. Calcium channel blockers are sometimes used to treat mania, though, so you might want to be cautious with them. This doesn't mean you should avoid them altogether; just be watchful for worsening of depression if you do decide to try them.
-elizabeth
Posted by dave_fox on October 15, 2001, at 12:35:31
In reply to Re: Blood pressure meds which can worsen depression? » dave_fox, posted by Elizabeth on October 12, 2001, at 10:29:27
Hi Elizabeth, thank you for your reply. I am very please there is someone like you here who is familiar with BP meds and their mood effects!
> > I had been wary of starting with beta-blockers for my
> > blood pressure because I heard somewhere that they
> > can cause depression. However Psychopharm Nut's
> > cutting suggests that this may not be the case.
>
> I think that it's *not* nearly as common a phenomenon
> as it used to be, although it may happen sometimes.
I wonder why it is not as common as it used to be? What has changed in the interim to make it less common?
> > We have started on an ACE-inhibitor but with no good
> > results yet.
>
> Which one? Like I said, sometimes you need multiple meds
> to treat hypertension. It can be really complicated.
I am on Ramipril. The doc has very recently increased my dose and is due to review it in a few weeks time. Do you know if the ACE-I meds differ amongst themselves? In other words, if Ramipril fails to work for me then would it be worth trying another from the same group?I was surprised to read on the Net (yeah, I know I need to be careful with Net information) that ACE-I drugs work in only about two-thirds of patients. Have you heard this?
> > The newer classes of BP meds (alpha blockers and AA)
> > are rather too expensive to try just yet (this is the UK here), > > so I supect that the calcium channel blockers will be next for me.
>
> What alpha antagonists are they using there? Phentolamine?
I am simply reading from my book of meds (with little true understanding as these sorts of meds are very new to me) so please excuse any possible errors. Both these categories are seen here are third level meds...Alpha-adrenoceptor blocking drugs:
doxazosin (UK: Cardura)
indoramin (UK: Baratol)
prozosin (UK: Prazosin, Hypovase)
terazosin (UK: Hytrin)Angiotensin-II Receptor Antagonists:
Angiotensin
cadesartan cilexetil (UK: Amias)
irbesartan (UK: Aprovel)
losartan potassium (UK: Cozaar)
valsartan (UK: Diovan)
> Calcium channel blockers are sometimes used to
> treat mania, though, so you might want to be cautious
> with them. This doesn't mean you should avoid them
> altogether; just be watchful for worsening of depression
> if you do decide to try them.
It seems best to avoid tempting fate by trying these meds. But I will keep an open mind if there is no alternative. I am told that if the ACE meds do not work that a common next step is to augment them with a thiazide diuretic. However, I am aware that these diuretics have a reputation for adverse sexual side effects and unless they are at a low dose then I would be reluctant to try them too soon.Dave
Posted by Elizabeth on October 16, 2001, at 17:39:50
In reply to Re: Blood pressure meds which can worsen depression?, posted by dave_fox on October 15, 2001, at 12:35:31
> > I think that it's *not* nearly as common a phenomenon
> > as it used to be, although it may happen sometimes.
>
>
> I wonder why it is not as common as it used to be? What has changed in the interim to make it less common?Err, I meant "as used to be thought." Sorry about that. (That is, a lot of cases of depression that might have been ascribed to beta blockers in the past probably weren't caused by the b-blockers after all.)
> I am on Ramipril. The doc has very recently increased my dose and is due to review it in a few weeks time. Do you know if the ACE-I meds differ amongst themselves? In other words, if Ramipril fails to work for me then would it be worth trying another from the same group?
That I don't know about -- my knowledge about BP meds only covers the areas relevant to psychiatry, if you know what I mean (e.g., whether they cause depression, how to treat antidepressant-induced hypertension, orthostatic hypotension caused by psych meds, etc.).
> I was surprised to read on the Net (yeah, I know I need to be careful with Net information) that ACE-I drugs work in only about two-thirds of patients. Have you heard this?
It's not that bad a record -- ADs work about equally often.
> Alpha-adrenoceptor blocking drugs:
>
> doxazosin (UK: Cardura)
> indoramin (UK: Baratol)
> prozosin (UK: Prazosin, Hypovase)
> terazosin (UK: Hytrin)Hmm. I was curious because phentolamine is the recommended drug to use for MAOI-associated acute hypertension, but it's not available in a pill in the US. I think a pill form is being studied (or was recently) for erectile dysfunction, of all things.
> It seems best to avoid tempting fate by trying these meds.
If you need medication for cardiovascular disease, you need it. I don't know how bad your BP problem is, whether there might be other ways to fix it, etc. Also don't be too surprised or discouraged if the first thing you try doesn't work by itself.
> I am told that if the ACE meds do not work that a common next step is to augment them with a thiazide diuretic. However, I am aware that these diuretics have a reputation for adverse sexual side effects and unless they are at a low dose then I would be reluctant to try them too soon.
Yeah, the sexual side effects of medications (antidepressants, antihypertensives, etc.) are often considered irrelevant by the physician, but they sure make a difference for patients! I don't know how frequent or serious the problem is with HCTZ, etc. -- maybe you would find the answer on a support group for people with cardiovascular disease, since people here can tell you everything that you want to know (or more than you wanted to know) about antidepressants' sexual side effects....
-elizabeth
Posted by dave_fox on October 16, 2001, at 17:57:10
In reply to Re: Blood pressure meds which can worsen depression? » dave_fox, posted by Elizabeth on October 16, 2001, at 17:39:50
There has been a really interesting side-effect from me taking Ramipril over the last five weeks or so. Of course, it could be pure co-incidence so I need to see how it goes.
The side-effect is that I feel less prone to getting angry or obsessive about things. I have an obsessive personality (Obsessive Compulsive Personality Disorder) but this last month or so I have been feeling really chilled out and less prone to enagage in my usual behaviors.
I very vaguely seem to remember reading that ACE-Inhibitors are sometimes used for people who are somewhat manic.
I can honestly say that I have not felt quite like this (less impulsive and less compulsive) for a very long time. I am not taking any other meds at the moment and have not been doing so for a few months.
Have you or anyone else here heard of this?
Dave
Posted by Cressida on October 17, 2001, at 14:36:31
In reply to Re: Blood pressure meds which can worsen depression?, posted by dave_fox on October 16, 2001, at 17:57:10
I have noticed similar positive effects from antihypertensive medication. I feel more relaxed and less anxious; think more clearly; less impulsive and obsessive as well. I have read, and was told by a doctor, that prolonged high blood pressure can create a host of symptoms, some of which are psychological. So, it makes sense that we're noticing improvement in other areas besides BP.
About your concern over whether BP meds can aggravate or cause depression, I wouldn't worry about it. I was worried a little at first too, because I take Remeron. I'd rather face the possibility of feeling slowed down than suffer a stroke or heart attack.
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