A beta-adrenergic antagonist reduces traumatic memories and PTSD symptoms in female but not in male patients after cardiac surgery.
BACKGROUND
Epinephrine enhances emotional memory whereas beta-adrenoceptor antagonists (beta-blockers, BBs) impair it. However, the effects of BB administration on memory are sex dependent. Therefore, we predicted differential effects of epinephrine and the BB metoprolol given to male and female patients after cardiac surgery (CS) on traumatic memories and post-traumatic stress disorder (PTSD) symptoms.


METHODS
We performed a prospective observational study and determined the number of standardized traumatic memories (NTRM) and PTSD symptom intensity in cardiac surgical patients at 1 day before surgery, and at 1 week and 6 months after the procedure. PTSD symptoms and NTRM were quantified using validated questionnaires. Metoprolol could be administered any time post-operatively.


RESULTS
Baseline NTRM was not significantly different between male (n=95) and female patients (n=33). One week after CS, the NTRM in male patients was significantly higher. Metoprolol had no significant effect in either sex. At 6 months, females with metoprolol (n=18) showed a significantly lower NTRM and significantly lower PTSD symptom scores than females without BBs (n=15, p=0.02). By contrast, the totally administered dosage of epinephrine correlated with NTRM in males (r=0.33, p<0.01) but not in females (r=0.21, p=0.29).


CONCLUSIONS
beta-Adrenergic stimulation with epinephrine enhances memory for adverse experiences in males but not in females whereas beta-blockade selectively reduces memory for post-operative adverse events and PTSD symptoms in females.
Krauseneck
T
T
Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany.
Padberg
F
F
Roozendaal
B
B
Grathwohl
M
M
Weis
F
F
Hauer
D
D
Kaufmann
I
I
Schmoeckel
M
M
Schelling
G
G
D000284:Administration, Oral; D000318:Adrenergic beta-Agonists / Q000494:pharmacology; D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D000368:Aged; D001026:Coronary Artery Bypass / Q000523:psychology*; D004305:Dose-Response Relationship, Drug; D004837:Epinephrine / Q000494:pharmacology; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000523:psychology*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D011939:Mental Recall / Q000187:drug effects*; D008790:Metoprolol / Q000494:pharmacology*; D008875:Middle Aged; D011446:Prospective Studies; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology*; D011795:Surveys and Questionnaires
D000318:Adrenergic beta-Agonists; D000319:Adrenergic beta-Antagonists; D008790:Metoprolol; D004837:Epinephrine