Psychiatria pre prax 3/2024

Cardiovascular treatment in patients with depression: The role of beta-blockers in current practice

Beta-blockers (BB) are among the cornerstone medications used in the treatment of cardiovascular diseases, such as coronary heart disease, post-myocardial infarction, angina pectoris, chronic heart failure, arrhythmias, and arterial hypertension. Their mechanism of action involves the blockade of beta-adrenergic receptors, which reduces sympathetic nervous system activity, leading to a decreased heart rate and blood pressure. However, there are significant pharmacokinetic and pharmacodynamic differences between individual drugs within this group, which can affect the efficacy and safety of treatment. These differences become even more pronounced in patients with depressive disorders, where interactions with antidepressants can influence the metabolism of beta-blockers. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine and paroxetine, can inhibit the CYP2D6 enzyme, leading to increased plasma levels of beta-blockers and, consequently, a higher risk of side effects such as bradycardia or atrioventricular block. These risks need to be carefully monitored to minimize clinical consequences. This article provides an overview of beta-blockers, their use, and clinical implications in the combined treatment of cardiovascular diseases and depression.

Keywords: betablockers, division, pharmacokinetic, pharmacodynamic, cytochrome P450 2D6, antidepressants, cardiovascular diseases