title: Initiation of β-blocker therapy and depression after acute myocardial infarction.
abstract: BACKGROUND
  Although β-blockers reduce mortality after acute myocardial infarction (AMI), early reports linking β-blocker use with subsequent depression have potentially limited their use in vulnerable patients. We sought to provide empirical evidence to support or refute this concern by examining the association between β-blocker initiation and change in depressive symptoms in AMI patients.
  
  
  METHODS
  Using data from 2 US multicenter, prospective registries of AMI patients, we examined 1-, 6-, and 12-month changes in depressive symptoms after the index hospitalization among patients who were β-blocker-naïve on admission. Depressive symptoms were assessed using the validated 8-item Patient Health Questionnaire (PHQ-8), which rates depressive symptoms from 0 to 24, with higher scores indicating more depressive symptoms. A propensity-matched repeated-measures linear regression model was used to compare change in depressive symptoms among patients who were and were not initiated on a β-blocker after AMI.
  
  
  RESULTS
  Of 3,470 AMI patients who were β-blocker-naïve on admission, 3,190 (91.9%) were initiated on a β-blocker and 280 (8.1%) were not. Baseline PHQ-8 scores were higher in patients not initiated on a β-blocker (mean 5.78 ± 5.45 vs 4.88 ± 5.11, P = .005). PHQ-8 scores were progressively lower at 1, 6, and 12 months in both the β-blocker (mean decrease at 12 months 1.16, P < .0001) and no-β-blocker groups (mean decrease 1.71, P < .0001). After propensity matching 201 untreated patients with 567 treated patients, initiation of β-blocker therapy was not associated with a difference in mean change in PHQ-8 scores at 1, 6, or 12 months after AMI (absolute mean difference with β-blocker initiation at 12 months of 0.08, 95% CI -0.81 to 0.96, P = .86).
  
  
  CONCLUSIONS
  Initiation of β-blocker therapy after AMI was not associated with an increase in depressive symptoms. Restricting β-blocker use because of concerns about depression appears unwarranted and may lead to undertreatment of AMI patients.
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, MO.
authors.forename: Anil M
authors.initials: AM
authors.lastname: Ranchord
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Buchanan
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, MO.
authors.forename: Kensey L
authors.initials: KL
authors.lastname: Gosch
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO. Electronic address: pchan@saint-lukes.org.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Chan
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D012042:Registries; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends
chemical_list: D000319:Adrenergic beta-Antagonists