Impact of cardiac medications on mood

Abstract

Cardiac medications including ß-blockers, cardiac glycosides, and antiarrhyth- mics have long been known to have CNS effects including alterations in mood, emotion state anxiety, and depression. While the predominant effects come from those with higher lipophilicity and when used at high doses, the evidence is actually quite mixed. At cardiac therapeutic doses, lipophilic ß-blockers like propranolol have actually few CNS effects on mood. The effectiveness of ß-blockers is established for relieving performance anxiety, but the actions involve more a peripheral relief of somatic symptoms rather than a central effect. By contrast the reduction in consolidation of aversive and stressful memory by propranolol appears to involve altering the functioning of the amygdala and hippocampus directly. While evidence suggests that ß-blockers reduce aggressive behaviors associated with various psychological conditions such as schizophrenia, they are now used relatively rarely. Cardiac glycosides such as digoxin have been implicated in causing a variety of mental dysfunctions including depression, yet quality prospective trials are lacking and evidence is largely anecdotal. The difficulty is that the patients likely to receive either ß-blockers or digoxin are often suffering heart failure which in itself causes mood alterations such as depression. The current review analyzes the evidence of mood-altering side effects for the various pharmacological agents used to treat cardiac disease.