Depression after ACS Linked to Vascular Changes in the Brain

A new study reveals that depression following ACS results in changes in the brain's white matter.

Although it has long been known that depression can occur in patients after acute coronary syndrome (ACS), a new study from researchers at Mount Sinai Medical Center, Columbia University, and Charité University Medical Center in Berlin is the first to examine changes that occur in the brain after ACS. The new research reveals that depressive symptoms after ACS are associated with vascular changes in the brain.

The team of researchers, led by Michael A. Rapp, Department of Psychiatry, Mount Sinai School of Medicine, scanned the brains of 22 patients for the presence of cerebral deep white matter changes and microstructural abnormalities in the anterior cingulate cortex (ACC) and dorsolateral prefrontal cortex 3 months after ACS. Using the Coffey Rating Scale of deep white matter changes and measures of fractional anisotropy derived from diffusion tensor imaging and the Beck Depression Inventory, as completed by patients, the researchers found that “depressive symptom severity at 3 months was negatively related to fractional anisotropy in the ACC (r = 0.72, p < 0.001), but this association disappeared when controlling for cardiovascular risk factors (p = 0.21).” Also, “in comparison to patients who were non-depressed at 3 months after hospitalization (n = 14), patients with persistent depressive symptoms (n = 8) exhibited more advanced deep white matter changes overall (p < 0.02), but not when controlling for cardiovascular comorbidity.” Patients who were persistently depressed also had lower fractional anisotropy in the ACC (p < 0.05), but this effect was not observed when the researchers controlled for modifiable cardiovascular risk factors.

“This study provides the first evidence that persistent depressive symptoms after ACS are associated with vascular brain changes,” the authors concluded in the Psychotherapy and Psychosomatics article. “Longitudinal studies are needed to determine whether depressive symptoms precede these changes or vice versa.”