Neuropsychiatric consequences of cardiovascular medications

Abstract

The use of cardiovascular medications can have a variety of neuropsychiatric consequences. Many cardiovascular agents cause higher rates of fatigue and sedation than placebo, and case reports of medication-induced mood syndromes, psychosis, and cognitive disturbances exist for many cardiovascular drugs. Depression has been associated with P3-blockers, methyldopa, and reserpine, but more recent syntheses of the data have suggested that these associations are much weaker than originally believed. Though low cholesterol levels have been associated with depression and suicide, lipid-lowering agents have not been associated with these adverse effects. Finally, cardiovascular medications may have beneficial neuropsychiatric consequences; for example, the use of clonidine in patients with attention deficit-hyperactivity disorder, the use of prazosin for patients with post-traumatic stress disorder; and the use of propranolol for performance anxiety and akathisia.

Neuropsychiatric Consequences of Lipophilic Beta-Blockers

“…By blocking beta-adrenergic receptors, the most common side effects are fatigue and cold extremities. Over time, beta-blocker treatment has been associated with a number of consequences for the central nervous system: fatigue, depression, sleep disorders and nightmares, visual hallucinations, delirium or psychosis, Parkinson’s disease, and the risk of falling [ 28 ].…”

“…Although the association between the use of beta-blocker treatment and the development of depression has been widely described over time, it is still a controversial topic nowadays. Several case reports and small general reports have suggested a relationship between propranolol and depression [ 28 ]. Specialists have proposed several mechanisms to explain a possible association between beta-blockers and depression in elderly patients, both through side effects regarding the sleep and circadian cycle regulation, as well as through sympathetic mediated feedback [ 36 ].…”

Depressogenic effects of medications: a review

“…In this section, we will review the links between depression and a variety of cardiovascular medications; we refer the reader to published reviews of their other neuropsychiatric complications. 52 , 53 …”

“…Calcium-channel blockers may be associated with fatigue, but they have not been associated with depression. 52 , 60 Verapamil has been the most-studied calcium-channel blocker for mania and bipolar disorder and it has had mixed, but generally positive, results; this agent may be a viable option for patients with bipolar disorder who are pregnant or who fail first-line therapies.…”

“…Hydralazine, a systemic vasodilator whose use is usually reserved for patients with severe hypertension, on occasion has been linked with neuropsychiatric side effects. Rarely, hydralazine has been associated with the onset of depression 52 ; overall it is not linked to mood disturbance. Nitrates (eg, nitroglycerin, isosorbide dinitrate, and nitroprusside), most commonly used to treat angina, have minimal neuropsychiatric side effects.…”