title: The Effect of Dexamethasone on Symptoms of Posttraumatic Stress Disorder and Depression After Cardiac Surgery and Intensive Care Admission: Longitudinal Follow-Up of a Randomized Controlled Trial.
abstract: OBJECTIVE
  Cardiac surgery and postoperative admission to the ICU may lead to posttraumatic stress disorder and depression. Perioperatively administered corticosteroids potentially alter the risk of development of these psychiatric conditions, by affecting the hypothalamic-pituitary-adrenal axis. However, findings of previous studies are inconsistent. We aimed to assess the effect of a single dose of dexamethasone compared with placebo on symptoms of posttraumatic stress disorder and depression and health-related quality of life after cardiac surgery and ICU admission.
  
  
  METHODS
  Follow-up study of a randomized clinical trial.
  
  
  METHODS
  Five Dutch heart centers.
  
  
  METHODS
  Cardiac surgery patients (n = 1,244) who participated in the Dexamethasone for Cardiac Surgery trial.
  
  
  METHODS
  A single intraoperative IV dose of dexamethasone or placebo was administered in a randomized, double-blind way.
  
  
  RESULTS
  Symptoms of posttraumatic stress disorder, depression, and health-related quality of life were assessed with validated questionnaires 1.5 years after randomization. Data were available for 1,125 patients (90.4%); of which 561 patients received dexamethasone and 564 patients received placebo. Overall, the prevalence of psychopathology was not influenced by dexamethasone. Posttraumatic stress disorder and depression were present in, respectively, 52 patients (9.3%) and 69 patients (12.3%) who received dexamethasone and in 66 patients (11.7%) and 78 patients (13.8%) who received placebo (posttraumatic stress disorder: odds ratio, 0.82; 95% CI, 0.55-1.20; p = 0.30; depression: odds ratio, 0.92; 95% CI, 0.64-1.31; p = 0.63). Subgroup analysis revealed a lower prevalence of posttraumatic stress disorder (odds ratio, 0.23; 95% CI, 0.07-0.72; p < 0.01) and depression (odds ratio, 0.29; 95% CI, 0.11-0.77; p < 0.01) in female patients after dexamethasone administration. Health-related quality of life did not differ between groups and was not associated with psychopathology.
  
  
  CONCLUSIONS
  Overall, our findings suggest that exogenous administration of the glucocorticoid receptor agonist dexamethasone-compared with placebo-during cardiac surgery does not positively or negatively affect the prevalence of posttraumatic stress disorder and depression. However, in female patients, beneficial effects on the occurrence of posttraumatic stress disorder and depression may be present.
authors.affiliation: 1Department of Anesthesiology and Intensive Care, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.2Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.3Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands.4Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.5Department of Anesthesiology, Isala Clinics, Zwolle, The Netherlands.6Department of Anesthesiology, University Medical Center Groningen, Groningen, The Netherlands.7Department of Anesthesiology, Amphia Hospital, Breda, The Netherlands.8Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands.9Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Lotte
authors.initials: L
authors.lastname: Kok
authors.forename: Manon H
authors.initials: MH
authors.lastname: Hillegers
authors.forename: Dieuwke S
authors.initials: DS
authors.lastname: Veldhuijzen
authors.forename: Sandra
authors.initials: S
authors.lastname: Cornelisse
authors.forename: Arno P
authors.initials: AP
authors.lastname: Nierich
authors.forename: Joost M
authors.initials: JM
authors.lastname: van der Maaten
authors.forename: Peter M
authors.initials: PM
authors.lastname: Rosseel
authors.forename: Jan
authors.initials: J
authors.lastname: Hofland
authors.forename: Milou S
authors.initials: MS
authors.lastname: Sep
authors.forename: Jan M
authors.initials: JM
authors.lastname: Dieleman
authors.forename: Christiaan H
authors.initials: CH
authors.lastname: Vinkers
authors.forename: Linda M
authors.initials: LM
authors.lastname: Peelen
authors.forename: Marian
authors.initials: M
authors.lastname: Joëls
authors.forename: Diederik
authors.initials: D
authors.lastname: van Dijk
mesh_terms: D006348:Cardiac Surgical Procedures; D003863:Depression / Q000188:drug therapy* / Q000209:etiology; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011183:Postoperative Complications / Q000188:drug therapy*; D011788:Quality of Life; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy* / Q000209:etiology; D011795:Surveys and Questionnaires
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone