To the Editor.—
The recent article by Avorn et al1 on increased antidepressant use in patients taking β-blockers appears to be a "chicken-and-egg" problem when viewed from a perspective that is different from that of the authors. Their conclusion—"we consistently found a higher frequency of antidepressant use among patients prescribed β-blockers"—should be examined as to the validity of the reverse case: the frequency of β-blockers use among patients prescribed tricyclic antidepressants (TCAs).Since the overall frequency of use is greater for TCAs than for β-blockers in two age groups (20 to 44 and older than 65 years), can their use be attributed to β-blockers use? The finding that β-blocker use is greater than that of other antihypertensive drugs may simply confirm the results of the survey quoted by the authors, ie, that β-blockers are more frequently prescribed than other drugs. This may equally apply to hypertensives among a population
Appel WC. Antidepressant Use in Patients Prescribed β-Blockers. JAMA. 1986;255(23):3248. doi:10.1001/jama.1986.03370230054021
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