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-Blocker Therapy and Depression

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: In their review article, Dr Ko and colleagues¹ found no significant increased risk of depressive symptoms and only small increased risk of fatigue and sexual dysfunction associated with -blocker therapy. They concluded that concerns about depression, fatigue, and sexual dysfunction should not deter physicians from initiating -blocker therapy. I would like to raise the following caveats.

First, in addition to varying degrees of lipid solubility and generation, there are other pharmacological differences among -blockers. Several -blockers, such as pindolol, have antagonistic activity at somatodendritic 5-HT_1A autoreceptors, and thereby increase serotonin release.² This action may lead to an improvement in depression. Räsänen et al³ reported that treatment with pindolol was associated with a slightly but significantly lower rate of antidepressant use, suggesting that pindolol may have some beneficial effects on mood. Although Ko et al used a random-effects model to account for heterogeneity between studies, they should have . . . [Full Text of this Article]

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