Beta Blockers vs. SSRIs

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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Beta blockers vs. SSRIs

  • Beta-blockers are used to treat high blood pressure (hypertension) and congestive heart failure, to prevent kidney failure in patients with high blood pressure or diabetes, to reduce the risk of stroke, abnormal heart rhythms, chest pain (angina), tremors, pheochromocytoma, hypertrophic subaortic stenosis, and to prevent migraines.
  • SSRIs (elective serotonin reuptake inhibitors) are a type of antidepressant used to treat depression.
  • One similarity is that some beta-blockers and some SSRIs may be used to treat anxiety.
  • Examples of beta-blockers include acebutolol (Sectral), atenolol (Tenormin), betaxolol (Kerlone), bisoprolol fumarate (Zebeta), carteolol hydrochloride (Cartrol), metoprolol tartrate (Lopressor), metoprolol succinate (Toprol-XL), nadolol (Corgard), penbutolol sulfate (Levatol), pindolol (Visken), propranolol hydrochloride (Inderal), solotol hydrochloride (Betapace), and timolol maleate (Blocadren).
  • Examples of SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox, Luvox CR), paroxetine (Paxil, Paxil CR, Pexeva), sertraline (Zoloft), and vilazodone (Viibryd).
  • Side effects that are similar in beta-blockers and SSRIs include:
    • Insomina
  • Common side effects of beta-blockers that are different from SSRIs include:
    • Cold hands and feet
    • Tiredness or depression
    • Slow heartbeat
    • Symptoms of asthma
    • Impotence
  • Common side effects of SSRIs that are different from beta-blockers include:
    • Headaches
    • Nausea
    • Vomiting
    • Diarrhea
    • Restlessness
    • Agitation
    • Sexual dysfunction
    • Weight gain or loss

What are beta blockers and SSRIs?

Beta-blockers, also known as beta-adrenergic blocking agents, block norepinephrine and epinephrine (adrenaline) from binding to beta receptors on nerves.

These hormones are what cause the physical symptoms of anxiety and blocking them reduces these effects, helping control some of the physical symptoms of anxiety. This also helps reduce the heart rate and lower blood pressure.

SSRIs (elective serotonin reuptake inhibitors) are a type of antidepressant that works by increasing the amount of serotonin in the brain.

What are the side effects of beta blockers and SSRIs?

Beta Blockers

Beta blockers may cause:

  • Diarrhea
  • Stomach cramps
  • Nausea
  • Vomiting

Other important side effects include:

  • Rash
  • Blurred vision
  • Disorientation
  • Insomnia
  • Hair loss
  • Weakness
  • Muscle cramps
  • Fatigue

As an extension of their beneficial effect, they slow heart rate and reduce blood pressure, but they may cause adverse effects such as heart failure or heart block in patients with heart problems.

Beta blockers should not be withdrawn suddenly because sudden withdrawal may worsen angina (chest pain) and cause heart attacks, serious abnormal heart rhythms, or sudden death.

  • Central nervous system effects of beta blockers include:
    • Headache
    • Depression
    • Confusion
    • Dizziness
    • Nightmares
    • Hallucinations

Beta blockers that block β2 receptors may cause shortness of breath in asthmatics.

As with other drugs used for treating high blood pressure, sexual dysfunction may occur.

Beta blockers may cause low or high blood glucose and mask the symptoms of low blood glucose (hypoglycemia) in people with diabetes.

Other serious side effects of beta-blockers include:

  • Toxic epidermal necrolysis
  • Raynaud's phenomenon
  • Lupus erythematosus
  • Bronchospasm
  • Serious allergic reactions
  • Erythema multiform
  • Steven Johnson Syndrome
  • Toxic epidermal necrolysis

SSRIs

  • Headaches: SSRIs cause headaches and dose-related nausea, vomiting, and diarrhea that improve with continued treatment.
  • Insomnia, restlessness, agitation: Insomnia, restlessness, and agitation-which decrease over time-also are associated with SSRIs. Insomnia can be treated with low dose (50-100 mg) trazodone (Desyrel) at bedtime and agitation may be managed by reducing the SSRI dose or treating with anti-anxiety drugs.
  • Sexual dysfunction: SSRIs also are associated with sexual dysfunction. Symptoms of sexual dysfunction in men may be treated with sildenafil (Viagra), yohimbine (Pausinystalia yohimbe), amantadine (Symmetrel), cyproheptadine, or neostigmine (Prostigmin).
  • Weight gain or loss: Over time, weight loss or weight gain has been associated with SSRIs. Patients may experience weight loss initially but quickly regain weight.

What drugs interact with beta blockers and SSRIs?

Beta Blockers

  • Combining propranolol (Inderal) or pindolol (Visken) with thioridazine (Mellaril) or chlorpromazine (Thorazine) may result in low blood pressure (hypotension) and abnormal heart rhythms because the drugs interfere with each other's elimination and result in increased levels of the drugs.
  • Dangerous elevations in blood pressure may occur when clonidine (Catapres) is combined with a beta blocker, or when clonidine or beta blocker is discontinued after their concurrent use. Blood pressure should be closely monitored after initiation or discontinuation of clonidine or a beta blocker when they have been used together.
  • Phenobarbital and similar agents may increase the breakdown and reduce blood levels of propanolol (Inderal) or metoprolol (Lopressor, Toprol XL). This may reduce effectiveness of the beta blocker.
  • Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) (for example, ibuprofen) may counteract the blood pressure reducing effects of beta blockers by reducing the effects of prostaglandins, which play a role in control of blood pressure.
  • Beta blockers may prolong hypoglycemia (low blood sugar) and mask symptoms of hypoglycemia in diabetics who are taking insulin or other diabetic medications.

SSRIs

  • Confusion, high blood pressure, tremor, hyperactivity, coma, and death may occur when SSRIs are combined with other drugs that increase brain serotonin levels, for example, MAOIs, TCAs, sumatriptan (Imitrex), linezolid (Zyvox), St John's Wort, tramadol (Ultram), and meperidine (Demerol).
  • The risk of gastrointestinal bleeding may be increased when SSRIs are combined with nonsteroidal anti-inflammatory drugs (NSAIDs).
  • SSRIs may increase the effect of the blood thinner warfarin (Coumadin, Jantoven), leading to excessive bleeding. Therefore, warfarin therapy, and patients taking NSAIDs should be monitored more frequently with PT/INR testing in individuals who also are taking SSRIs.

What are the different beta blockers and SSRIs available?

Beta Blockers

  • acebutolol (Sectral)
  • atenolol (Tenormin)
  • betaxolol (Kerlone)
  • betaxolol (Betoptic S)
  • bisoprolol fumarate (Zebeta)
  • carteolol (Cartrol, discontinued)
  • carvedilol (Coreg)
  • esmolol (Brevibloc)
  • labetalol (Trandate [Normodyne - discontinued])
  • metoprolol (Lopressor, Toprol XL)
  • nadolol (Corgard)
  • nebivolol (Bystolic)
  • penbutolol (Levatol)
  • pindolol (Visken, discontinued)
  • propranolol (Hemangeol, Inderal LA, Inderal XL, InnoPran XL)
  • sotalol (Betapace, Sorine)
  • timolol (Blocadren, discontinued)
  • timolol ophthalmic solution (Timoptic, Betimol, Istalol)

SSRIs

  • citalopram (Celexa)
  • escitalopram (Lexapro)
  • fluoxetine (Prozac, Sarafem)
  • fluvoxamine (Luvox)
  • paroxetine (Paxil, Paxil CR, Pexeva)
  • sertraline (Zoloft)

FDA Prescribing Information

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Reviewed on 10/6/2017
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