Beta blockers are linked to a range of adverse effects, especially depression. But only sleep problems stand out as a key issue in a new meta-analysis.

The drugs, commonly used to slow the heart rate and reduce blood pressure in heart disease, have been tied to depression risk and other side effects, such as anxiety, sleep disturbance and hallucinations. The study from Charité, a medical teaching hospital in Germany, is first to assess the full range of psychiatric side effects in the existing literature, the researchers said.

Their analysis included 285 studies involving more than 53,000 participants and 24 types of beta blockers. There was no evidence of a link between the drugs and most of the psychiatric side effects studied, including anxiety and loss of appetite, memory or libido. But some patients developed sleep-related symptoms. These symptoms included sleep disturbance and abnormal dreams, reported Reinhold Kreutz, M.D., director of Charité’s Institute of Clinical Pharmacology and Toxicology. In fact, some patients described discontinuing the drugs for this reason. 

In contrast, depression did not occur any more frequently during beta blockers treatment than with a placebo, he and his colleagues wrote. And there was no drug discontinuance found for depression, he added.

The authors emphasized that patients with a history of cardiovascular problems such as heart attack or stroke are prone to mental health issues and should be monitored for signs of developing problems. But this advice should not necessarily affect treatment with beta blockers, they said.

“Our results show that concerns regarding undesirable psychiatric effects, in particular depression, should not influence the decision-making process regarding the use of beta blockers,” concluded Kreutz and colleagues. “For the most part, beta blockers have a good psychiatric safety profile.”

Full findings were published in the journal Hypertension.