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June 20, 1986

Antidepressant Use in Patients Prescribed β-Blockers

Author Affiliations

University of Vermont College of Medicine Burlington

JAMA. 1986;255(23):3248. doi:10.1001/jama.1986.03370230054019

To the Editor.—  The article by Avorn et al1 on increased antidepressant use in patients prescribed β-blockers does not establish β-blockers as a frequent cause of depression. There is a considerably higher incidence of migraine in patients with depression, independent of drug use considerations, yet apparently no effort was made to exclude patients with a diagnosis of migraine. In addition, tricyclic antidepressants (TCAs) as well as β-blockers are used in the treatment of migraine, and if no effort was made to identify or exclude migraine patients, it would seem invalid to suggest that patients being treated with β-blockers and a TCA for headache could not account for the effect observed.The observation that the magnitude of the association between β-blockers and treatment for depression seemed to decline with advancing age could in fact reflect the declining incidence of migraine in this age group. Pharmacokinetic considerations would suggest that if