Does Vascular Depression Exist?

Does Vascular Depression Exist?
A prospective study suggests that atherosclerosis does not contribute to depression but leaves open other possible associations between vascular disorders and late-onset depression.
Because late-onset depression is associated with white-matter hyperintensities and other vascular brain abnormalities, cerebrovascular disease has been hypothesized as a cause. In this Dutch prospective study, investigators examined whether extracerebral vascular disease (a proposed proxy measure of cerebrovascular disease) predicts later depression. The 3564 participants (mean age, 72) had no depression at baseline and were part of a larger study of risk factors for chronic diseases. At baseline, participants underwent measurement of carotid artery plaque and intima–media thickness, aortic calcification, and ankle-brachial blood pressure (a measure of peripheral artery disease). A subset also had coronary artery calcification measured.
Depression was assessed both through screening interviews at interim assessments with formal diagnostic interviews that followed positive screens and through continuous review of medical and pharmacy records. During follow-up (mean, 5.9 years), 12.0% of participants developed depressive symptoms, 5.5% developed a depressive syndrome, and 1.6% developed major depressive disorder. No single measure of atherosclerosis or combination of measures predicted depressive symptoms or disorders.
Comment: Atherosclerosis is the most common cause of cerebrovascular disease, so careful prospective assessment of extracerebral vascular disease may be a valid marker of brain involvement. If so, the association between the two conditions probably does exist, but the current findings indicate that presumed cerebral atherosclerosis does not cause geriatric-onset depression. Instead, the authors suggest, depression may predispose to vascular disease (potentially via increased secretion of inflammatory cytokines; JW Psychiatry Mar 29 2010), or some common mechanism might predispose to both conditions. The authors did not consider the possibility that hypertension might predispose to late-onset depression; 42% of study participants were taking antihypertensive drugs. Because late-onset depression responds to antidepressants, clinicians should treat it vigorously, regardless of whether vascular disease is also present.
— Steven Dubovsky, MD