Journal of Psychosomatic Research, Vol. 36. No. 3, pp. 229-236, 1992. W22-3999/92 $5.oO+.C@l Printed in Great Britain. 0 1992 Pergamon Press plc COGNITIVE EFFECTS OF BETA BLOCKERS JOEL E. DIMSDALE* and RUTH P. NEWTON (Received 29 May 1991; accepted in revised zyxwvutsrqponmlkjihgfedcbaZYXWVUTS form 14 August 1991) zyxwvutsrqponmlkjihgfedcb Abstract-This study examined the effects of atenolol and metoprolol on neuropsychologic functioning, mood, sedation, and sleep. Following tapering of antihypertensive medication and a 3-wk placebo washout, 35 hypertensive patients were randomized to receive double-blind either atenolol or metoprolol for 4 wk. There was no consistent evidence that beta blocker treatment was associated with a deleterious effect on neuropsychologic functioning. The neuropsychologic effects of the drugs did not differ. There were also no significant changes in mood as assessed by the Profile of Mood States as a consequence of treatment with a beta blocker. However, there was a trend for patients receiving metoprolol to report a poorer mood profile. There was no overall or differential drug effect on deep sleep or sedation. On both drugs, however, patients complained of disturbing dreams @ < 0.04); however, the two drugs did not differ in this regard. On both medications patients had substantial complaints of fatigue; how- ever, it is inappropriate to attribute this to the medication since there were equivalent complaints on placebo. INTRODUCTION THIS study compared the neuropsychologic and subjective side effects of hyper- tensive patients treated double-blind with atenolol or metoprolol. Although beta blockers are effective and widely used medications there have been repeated com- plaints of cognitive side effects on beta blockers. Some have suggested that the more lipophilic (fat soluble) beta blockers have more of these effects. A recent review on this topic examined English and German articles published between 1970 and 1988 [ 1 ] . Although there is a large literature (over 55 published articles), this literature is far from consistent. First off, almost half of these articles are based on small sample sizes, i.e. < 20 subjects. Secondly, there are many domains in neuropsychologic testing, and the blockers have no across-the-board neuropsychologic effects. There is little replicated evidence that the drugs affect memory. There is some evidence suggesting that they decrease perceptual motor functioning and some suggestion that they may improve complex task performance. The literature suggests no consistent effect of lipophilicity on these effects. There are consistent reports of subtle sedation or fatigue associated with receipt of a beta blocker, but again there is little evidence that the symptoms are worse on lipophilic agents. Finally, there has been a fine peppering of reports suggesting depressive symptoms associated with receipt of these medications, but these publications are mainly case reports. This study compares the effects of a lipophilic beta blocker (metoprolol) with a non-lipophilic blocker (atenolol) on neuropsychologic functioning, mood, sleep, and sedation. Department of Psychiatry, University of California, San Diego. *Author to whom correspondence should be addressed at: UCSD (T-004), La Jolla, CA 92093.0804, U.S.A. 229