The mood and memory effects of beta-blockers are subtle, and despite some reviews in the medical literature, I do believe that this is clinically significant. INdeed, the fatigue associated with carvedilol seems to be greater than that associated with older agents.
Today I saw a patient who has been on carvedilol for about 10 months – and her ejection fraction has improved from 30% to 55%. But she's terribly depressed and feeld so fatigued that she can't do anything.
The SSRI has done rather little – and today I called her cardiologist and we agreed to stop the cavedilol for a month or so and wee what happens.
A 45 year old with hypertension felt that the metoprolol was doing fine. But after a bit of careful discussion and a zung scale – I learned that he had depression. This is the trouble with much of behavioral medicine. Since the medication isn't discontinued – the problems are very likely more common than the studies suggest.