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The Beta Blocker Blahs Can Be Debilitating

Beta blockers like atenolol, metoprolol and propranolol used to be very popular BP drugs. But the beta blocker blahs can be problematic. What else works?
Lonely young man outside at house balcony looking depressed destroyed sad and suffering emotional crisis and grief on an urban background

Beta blockers are blood pressure medications that have been around for many decades. They include drugs like atenolol (Tenormin), metoprolol (Toprol) and propranolol (Inderal). In some instances, such as hypertrophic cardiomyopathy, metoprolol can be essential. For a long time, such drugs were first-line approaches for treating hypertension. However, there is now some doubt about the wisdom of this approach (Pharmacological Research, Jan. 2020). For one thing,  people often complain of the beta blocker blahs or the beta blocker blues.

The Beta Blocker Blahs in Real Life:

Q. Thank you for writing about beta blockers making you feel like rubbish. I was diagnosed with high blood pressure eight years ago (140/80). My doctor prescribed atenolol.

It did NOTHING for my blood pressure, so after a couple of months my GP added perindopril. WOW! My blood pressure went to 120/70 in two days.

In the meantime, my heart rate that was formerly 80 or 90 BPM was now at 60 or less. Any task was so tiring! I have now passed 60 years of age and I could barely split wood.

When I realized this might be due to the atenolol, I halved the dose for two weeks, then halved it again for another two weeks. Now, a month later, my resting heart rate is back to 80. My blood pressure is 125/75 thanks to the perindopril. I can split wood, walk and even run again. For the past eight years on the beta blocker, I felt like I would pass out if I tried to run. Cheers from Australia.

The Beta Blocker Blahs Can Slow You Down:

A. You are not the first person to complain about the beta blocker blahs. One man reported that atenolol brought his blood pressure down to 130/63 but left him feeling “extremely fatigued.”

Another blamed metoprolol for his “fatigue, tiredness, blahs and depression.”

A woman in Texas complained about propranolol. She said it took away all motivation to work, cook or interact with others. After six months she was really depressed. She asked the nurse in her cardiologist’s office if the propranolol could be part of the problem. The answer: “unlikely.”

When Jasmine saw her cardiologist he said that depression is a common side effect of beta blockers. Not surprisingly, Jasmine was more than a little annoyed that no one bothered to mention that before prescribing a beta blocker.

Another reader offered this testimonial:

Q. I had been taking atenolol for several years when it became unavailable. My doctor switched the prescription to metoprolol.

After taking it for about six months, I realized I was feeling depressed. I asked my cardiologist if it could be the metoprolol. He said definitely because that med crosses the blood/brain barrier.

Fortunately, atenolol is available now, so I am taking it again and doing fine. My blood pressure is very well controlled.

A. Metoprolol has a greater affinity for brain tissue than atenolol. This might explain your experience with depression (Pharmacology & Therapeutics, 1990, vol. 46, no. 2).  Other side effects of beta blockers like atenolol, metoprolol or propranolol include sleep disturbances and nightmares as well as fatigue, cold hands and feet, shortness of breath and slow heart rate.

Learn more about the beta blocker blahs at this link:

Is Your Blood Pressure Medicine Making You Sad and Depressed?

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Never Stop a Beta Blocker Suddenly!

We always worry that abrupt discontinuation of a beta blocker could lead to serious heart complications. If the prescriber agrees that a beta blocker should be discontinued, then it should be done gradually under medical supervision.

Find out why beta blockers are no longer considered first line treatments for hypertension at this link:

Back Pedaling on Beta Blockers (Atenolol, Metoprolol, Propranolol) for Hypertension

What About Perindopril (Aceon)?

Perindopril (Aceon) is an ACE inhibitor and is considered a first-line blood pressure treatment. Beta blockers, on the other hand, are no longer deemed the best choice for blood pressure control. They can cause fatigue and slow heart rate.

You can learn more about these medications and other approaches to manage hypertension in our Guide to Blood Pressure treatment. It is available in the health guide section.

Share your own story about blood pressure treatment in the comment section. Have you ever experienced the beta blocker blahs? What was that like?

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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Citations
  • Fumagalli C et al, "β-blockers: Their new life from hypertension to cancer and migraine." Pharmacological Research, Jan. 2020. DOI: 10.1016/j.phrs.2019.104587
  • McAinsh J & Cruickshank JM, "Beta-blockers and central nervous system side effects." Pharmacology & Therapeutics, 1990, vol. 46, no. 2. DOI: 10.1016/0163-7258(90)90092-g
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I took lisinopril, and three weeks later I had lost my balance control and began falling. I developed shortness of breath and became incontinent.

After reading your article, I feel like I have been validated. It was a few years ago, by which time I had been suffering from depression for years. I went through every antidepressant on the market. I remember it so well because it was Christmas. This particular year I was feeling especially depressed. I felt as if I was really having a breakdown. I had tried to figure out why and thought that it was the bisoprolol. Out of office hours, during Christmas holiday, I called my cardiologist and left a very emotional message begging for something and blaming bisoprolol. When nurse Michelle called me back, she said she felt so bad for me when she heard the message. That’s how badly I was affected.

I recently experienced my first AFIB episode and was prescribed Metoprolol and Eliquis. I have since experienced other pronounced episodes which I have recorded with my Kardia device. When I complained of dizziness, lethargic feelings, tiredness, I was told that my AFIB is occurring at a higher rate; that I do not feel it enough to notice and record it; and I was a good candidate for ablation.

Doing more research, I noticed that the side effects of Metoprolol were similar to the symptoms of frequent AFIB episodes and requested a heart monitor test to determine if and when I am having the AFIB episodes. Results of AFIB during a two week period were miniscule. I chose no ablation. Now that I understand the side effects of metoprolol I exercise more and tend to dismiss the tired feelings and blahs and go on with life.

I’ve been on Metoprolol for approximately 10 years following an NSTEMI. For the past 3 years I’ve felt dizzy, fatigued, and just plain crummy. EKG, Stress test, etc. normal. I really think it’s because I was switched to generic medications of Crestor and Metoprolol. MDs completely scoff at that but not sure what else it could be. New guidelines don’t even recommend continuing Metoprolol for MIs w/ nml EF for more than 3 years. I was treated under old guidelines.

Before my bypass surgery, I was on toprol. After surgery Dr took me off. I had Reynauds on my fingers. Since then, I haven’t had symptoms. This was 9 yrs ago.

Yes!!! I became depressed on Coreg and then started to get chest pain/discomfort. I was told ‘not to worry about the depression, and keep exercising,’ and I was given long acting nitro for my chest pains. Well, I had even more chest pains. My friend, a cardiac PA told me both meds could cause chest pain. I was only on the nitro stuff a few weeks so I weaned off that and then weaned off the Coreg. Both my chest pain and depression are gone. I control my BP via 400 mg of Indian Snakeroot and 2 caps twice a day of Hawthorn. My BP is 120/60. My cardiologist just shrugs and suggests that I try a calcium channel blocker. NOPE.

Weaning off nitro (only on it a few weeks) was 1.5 weeks. Weaning off Coreg (on it for 6 months) was 3 weeks. I had been on 3.25 x 2.

Currently on lisinopril 40 mg daily. As an RN, I know that there can be different side effects. What I hadn’t thought about is that you can be on a drug for years without problems and suddenly, without warning, have a problem with that drug.

I noticed last year that I was developing a distinct tremor in my arms/hands. Well, I’m not getting any younger, I thought. I did do a search for side effects on each prescription drug I take. Hmmm . . . turns out ACE inhibitors can cause tremors. I decided to see if that was my problem without stopping the drug. I was aware of the tremors and when they occurred. Waking up: no tremors. Wait several hours. Take my meds. Within 2 hrs I have tremors so bad that I can’t do anything on my computer since I can’t run the mouse. It scoots all over the screen. Sometimes I can do okay by holding the right hand with the left and push down. It gets so bad some days, I keep my hands away from my face. Don’t want to poke my eye out! Seeing MD in 10 days. I will be switching to a different class of drugs!

ACE inhibitors can cause renal failure.

They can, but renal failure as a result of ACE inhibitors is very uncommon. Still, patients should be warned of the possibility. Thanks for the reminder.

I’m 72 years old and I’ve been on Atenolol since 2000 and it’s done nothing but wonders for me! My heart rate was in the 120s before I started the drug. My b/p was 180/135. I was a nervous wreck. My hands shook. Atenolol slowed my heart to 63, come rain or shine, and I like that. My b/p came down within a couple of hours after taking the very first pill. My heart skipped beats all my life, even as a child. It does not skip beats on Atenolol–never! I’m calmer. (It also takes away shyness). I don’t tremble at the least little thing. I can breathe easier. No side effects. Atenolol is the best thing that ever came my way, and I have to stand up for it because it gets a bad rap these days. I’m sure it’s not for everyone, but it’s the one for me.

Beta blockers work on the fight or flight mechanism in our body. They decrease the fight response, specifically they are competitive antagonists that block the receptor sites for the endogenous catecholamines epinephrine (adrenaline) and norepinephrine (noradrenaline) on adrenergic beta receptors, of the sympathetic nervous system, which mediates the fight-or-flight response. (from wikipedia https://en.wikipedia.org/wiki/Beta_blocker)
So with less flight, fatigue is very possible, especially as you adjust to the med.
I am taking the beta blocker Prazosin for PTSD and it has helped the PTSD tremendously. This is because PTSD causes hypervigilance and nightmares almost all of the time (one is continually in fight mode).
It did take awhile for me to adjust to it – changing how your whole body nervous system works is very confusing to your body. I bounced around, up and down. But it was worth the ride. One interesting thing in that my digestion always seemed sluggish to me. That was because in fight mode all the time, energy was being sent to fight parts of the body (heart etc.) before lesser important functions like digestion. My digestion improved on Prazosin.

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