Heart in mind, mind in heart. Neurobiological aspects of depression post myocardial infarction

PhD ceremony: Ms. D.M. Tulner, 16.15 uur, Aula Academiegebouw, Broerstraat 5, Groningen

Dissertation: Heart in mind, mind in heart. Neurobiological aspects of depression post myocardial infarction

Promotor(s): prof. J. Korf, prof. J.A. den Boer, prof. A. Honig

Faculty: Medical Sciences

The number of patients with cardiovascular diseases increases in an ageing population. Although treatment modalities of cardiovascular diseases are improving, relatively little is known about mood disorders after a myocardial infarction (MI). The focus of this thesis was to investigate (neuro)biological factors of depression post MI, and the effects of antidepressant treatment.

It was demonstrated that depressive symptoms during hospitalization after MI were associated with the presence of cerebral white matter lesions. Moreover, in 80% of the patients the protein S100B was measured in the serum during the first week post MI. S100B is a marker for cerebral damage. The elevated levels of S100B were associated with depressive symptoms 3-12 months post infarction.

Thirty percent of the patients were depressed at 18 months post MI. Most of them were not treated according to the psychiatric guidelines. Mirtazapine appeared to be an effective antidepressant, but not for all patients. Patients who responded well to antidepressant treatment had fewer cardiac adverse events in the follow up period, as compared to patients not responding to antidepressant treatment. It was found that the antidepressant effect of mirtazapine was mediated through the immune system.