187:
547:
219:‘severe’ demonstrate the strongest association with depression. These white matter lesions also predict future depression risk in individuals that are not currently depressed: non-depressed participants with identified white matter lesions were eight times more likely to develop depression within the next three years compared to those without these lesions. Although the location of these lesions has been studied in connection to late-life depression, more research is needed to determine location's role in the presentation of vascular depression.
166:. Individuals with vascular depression also tend to have more deficits in self-initiation and concentration, higher cardiac illness burden and cerebrovascular risk factors, cognitive impairment (as associated with the severity of white matter lesions in the brain), and increased treatment resistance. Those with vascular depression have also reported increased lassitude, which is described as a difficulty getting started in the morning and may be related to
270:
factors, and it may likely be both. White matter lesions, proposed to be a causal risk factor, are common in the elderly and are associated with age. Depression and cerebrovascular risk factors are also common in later life. These factors make it difficult to determine what is the causal factor and to tease apart normal functioning from abnormal in the elderly population.
195:
factors. These two mechanisms parallel the differences between MRI and clinically defined vascular depression, yet do not necessarily represent contradictory mechanisms. These brain changes are thought to be reflected in the white matter lesions identified by MRI. Cerebrovascular risk factors for vascular depression include
161:
of vascular depression which provides initial support for its classification as a unique subtype. The most distinctive symptoms of vascular depression compared to non-vascular depression include increased cognitive and executive impairment, proposed to be associated with cerebrovascular risk factors.
227:
Several studies show that the lesions associated with vascular depression are linked to poor depression treatment outcomes. A limitation of these studies is that they lack a measurement of cerebrovascular risk factors before and after the experimental interventions. Therefore, it is unknown if these
128:
Studies have not yet been conducted using this set of criteria, so it is unclear whether it provides an advantage over current standards. Some aspects of the criteria are not always necessary to diagnose individuals. For example, one study found that late-onset depression, executive dysfunction, and
269:
A second critique of vascular depression relates to the ambiguity about the causal direction between risk factors and depressive symptoms. It is very difficult to determine if cerebrovascular risk factors cause depressive symptoms or if depressive symptoms instead lead to a worsening of these risk
273:
A final challenge facing the vascular depression hypothesis is its lack of a formal definition. This makes the disorder fundamentally more difficult to study, especially considering that there is still no agreement on diagnostic criteria. Furthermore, some researchers have found that there is no
247:
placements have been shown to be effective treatments for some individuals with vascular depression. Individuals treated with TMS have reported decreased depressive symptoms. However, in one of these studies the results were based on clinically defined vascular depression. When participants were
218:
Research has found that white matter lesions are particularly important in predicting future depression. Increasing severity, or magnitude, of these lesions predicts an increase in depression over time (as studied in individuals who were already depressed). Additionally, lesions classified as
194:
Researchers hypothesize that vascular depression disrupts processes in certain parts of the brain to put individuals at risk for developing depression. Two primary mechanisms have been proposed: one associates white matter lesions (attributed to cardiovascular burden) and cerebrovascular risk
38:. Thus, it is difficult to determine if vascular depression can be considered a distinct sub-type of major depressive disorder (MDD). However, with current criteria, some studies estimate that vascular depression may account for over half of the cases of MDD in the elderly.
82:
Alternatively, clinically defined criteria as proposed initially by
Alexopoulos and colleagues (1997) includes dimensions of depressive symptoms, disability, and cognitive impairment. Specifically, DED syndrome has been characterized by a loss of interest in activities,
78:
lesions. The most severe lesion in an individual is scored based on predefined criteria and considered in combination with two measures of depressive symptomology. These white matter lesions are thought to disrupt emotional and cognitive functioning.
141:
There is inadequate evidence to support vascular depression as a distinct subtype of major depressive disorder due to mixed results. Specifically, it is difficult to differentiate a diagnosis of vascular depression from similar diagnoses, such as
870:
Fabre, I., Galinowski, A., Oppenheim, C., Gallarda, T., Meder, J. F., de
Montigny, C., … Poirier, M. F. (2004). Antidepressant efficacy and cognitive effects of repetitive transcranial magnetic stimulation in vascular depression: An open trial.
849:
Narushima, K., McCormick, L. M., Yamada, T., Thatcher, R. W., & Robinson, R. G. (2010). Subgenual
Cingulate Theta Activity Predicts Treatment Response of Repetitive Transcranial Magnetic Stimulation in Participants With Vascular Depression.
265:
to develop vascular depression. Some research claims that vascular brain disease is sufficient (but not necessary) for the development of depression, but others have found that ischemic disease may not even be a sufficient causal factor.
256:
There are several criticisms regarding the theory of vascular depression. One critique is with regard to the distinction between sufficient and necessary causes for vascular depression. A cause is considered sufficient if its presence is
177:
compared to both nondepressed individuals with vascular disease and healthy control participants. This provides support that these symptoms may be a result of vascular depression specifically and not solely individuals’ vascular disease.
785:
Simpson, S., Baldwin, R. C., Jackson, A., & Burns, A. S. (1998). Is subcortical disease associated with a poor response to antidepressants ? Neurological, neuropsychological and neuroradiological findings in late-life depression.
162:
Additionally, studies have reported that when compared to individuals with non-vascular depression, those diagnosed with vascular depression tend to be older, have a lower family history of mental illness, and have a history of
62:
and focuses on the link between clinical symptoms of cardiovascular risk and depressive symptoms. Both of these competing definitions are supported in the literature and provide a strategy to diagnose vascular depression.
578:
Naarding, P., Tiemeier, H., Breteler, M. M. B., Schoevers, R. A., Jonker, C., Koudstaal, P. J., & Beekman, A. T. F. (2007). Clinically defined vascular depression in the general population.
98:
Aizenstein and colleagues (2016) proposed diagnostic criteria for vascular depression that incorporate elements of both clinical and MRI-definitions. These diagnostic criteria are:
34:
There is no formal and accepted definition of vascular depression and the hypothesis requires further research to support the causal link between these vascular lesions and
274:
depression symptom profile specific to those with vascular risk factors, calling into question vascular depression's distinction from other depressive disorders.
248:
compared according to MRI defined vascular depression, there was no difference in antidepressant outcomes between those fitting this definition and those not.
806:
Taylor, W. D., Steffens, D. C., & Krishnan, K. R. (2006). Psychiatric
Disease in the Twenty-First Century: The Case for Subcortical Ischemic Depression.
671:
Krishnan, K. Ranga Rama; Taylor, Warren D.; McQuoid, Douglas R.; MacFall, James R.; Payne, Martha E.; Provenzale, James M.; Steffens, David C. (2004-02-15).
829:
Jorge, R. E., Moser, D. J., Acion, L., & Robinson, R. G. (2008). Treatment of
Vascular Depression Using Repetitive Transcranial Magnetic Stimulation 3.
598:
Bella, R., Ferri, R., Cantone, M., Pennisi, M., Lanza, G., Malaguarnera, G., … Pennisi, G. (2011). Motor cortex excitability in vascular depression.
559:
Alexopoulos, G. S., Meyers, B. S., Young, R. C., Kakuma, T., Silbersweig, D., & Charlson, M. (1997). Clinically defined vascular depression.
129:
subcortical gray lesions in individuals were useful for identifying vascular depression, but only the presence of deep white matter lesions was
726:
Armstrong, Nicole M.; Meoni, Lucy A.; Carlson, Michelle C.; Xue, Qian-Li; Bandeen-Roche, Karen; Gallo, Joseph J.; Gross, Alden L. (May 2017).
373:
Alexopoulos, GS; Meyers, BS; Young, RC; Campbell, S; Silbersweig, D; Charlson, M (October 1997). "'Vascular depression' hypothesis".
616:
Dufouil, C.; de
Kersaint-Gilly, A.; Besançon, V.; Levy, C.; Auffray, E.; Brunnereau, L.; Alpérovitch, A.; Tzourio, C. (2001-04-10).
215:. However, these factors do not account for all cerebrovascular changes in individuals as genetics may play a large role as well.
27:. Subcortical ischemic depression refers to vascular depression specifically due to lesions and restricted blood flow, known as
728:"Cardiovascular risk factors and risk of incident depression throughout adulthood among men: The Johns Hopkins Precursors Study"
425:
Baldwin, RC (January 2005). "Is vascular depression a distinct sub-type of depressive disorder? A review of causal evidence".
228:
treatments are targeting these factors specifically or the more general categorization of late-onset geriatric depression.
31:, in certain parts of the brain. However, the disorder is typically described as vascular depression in the literature.
468:
Alexopoulos, George S.; Kiosses, Dimitris N.; Klimstra, Sibel; Kalayam, Balkrishna; Bruce, Martha L. (January 2002).
232:
173:
An additional study found that individuals with vascular depression reported greater executive dysfunction and
150:. Some researchers suggest that vascular depression may be too restricted in its definition and proposed
897:
47:
50:(MRI) or clinically defined criteria. MRI-defined vascular depression is more commonly referred to as
24:
546:
286:
can put individuals at risk for the development or increase of depressive symptoms in older adults.
66:
The criteria for MRI-defined vascular depression focus on the presence and severity of either deep
283:
84:
673:"Clinical characteristics of magnetic resonance imaging-defined subcortical ischemic depression"
208:
143:
115:
618:"Longitudinal study of blood pressure and white matter hyperintensities: the EVA MRI Cohort"
147:
282:
Vascular depression was defined in 1997 by
Alexopoulos and colleagues, who theorized that
8:
386:
186:
760:
727:
708:
653:
470:"Clinical presentation of the "depression-executive dysfunction syndrome" of late life"
450:
347:
320:
102:
Evidence of vascular pathology in elderly subjects with or without cognitive impairment
765:
747:
700:
692:
645:
637:
535:
489:
481:
442:
390:
352:
200:
167:
158:
35:
838:
712:
657:
530:
513:
454:
755:
739:
688:
684:
629:
525:
434:
382:
342:
332:
71:
815:
212:
105:
Absence of previous depressive episodes preceding obvious cerebrovascular disease
204:
743:
337:
190:
Proposed mechanism of vascular depression adapted from
Aizenstein et al., 2016
891:
751:
696:
641:
485:
244:
587:
859:
769:
704:
672:
649:
617:
539:
493:
469:
446:
356:
196:
163:
67:
394:
633:
75:
564:
514:"Therapeutic interventions for vascular depression: a systematic review"
261:
to lead to vascular depression, yet it is considered necessary if it is
240:
236:
438:
615:
58:
in the brain and depressive symptoms. An alternative definition is
54:(SID) and emphasizes the relationship between MRI identification of
880:
151:
119:
88:
28:
467:
92:
55:
23:, is a medical condition most commonly seen in older people with
114:
Clinical symptoms characteristic of vascular depression such as
318:
174:
372:
136:
670:
111:
Co-incidence of depression with cerebrovascular risk factors
321:"Vascular depression consensus report - a critical update"
319:
Aizenstein, HJ; Baskys, A; et al. (3 November 2016).
852:
The
Journal of Neuropsychiatry and Clinical Neurosciences
725:
46:
Vascular depression is typically diagnosed using either
512:
Brunoni, AR; Benseñor, IM; Alves, TC (December 2011).
91:, and cognitive impairment in the domains of language
511:
124:
Neuroimaging data confirming cerebrovascular disease
839:https://doi.org/10.1001/archgenpsychiatry.2007.45
368:
366:
314:
312:
310:
308:
306:
304:
302:
300:
298:
889:
133:to classify individuals as having the disorder.
60:depression executive dysfunction (DED) syndrome
816:https://doi.org/10.1016/j.biopsych.2006.05.028
802:
800:
363:
295:
873:International Journal of Geriatric Psychiatry
553:
427:International Journal of Geriatric Psychiatry
474:The American Journal of Geriatric Psychiatry
797:
70:lesions, often referred to as white matter
781:
779:
574:
572:
137:Distinction from Major Depressive Disorder
843:
759:
600:International Journal of Psychophysiology
588:https://doi.org/10.1017/S0033291706009196
529:
507:
505:
503:
420:
418:
416:
414:
412:
410:
408:
406:
404:
346:
336:
860:https://doi.org/10.1176/jnp.2010.22.1.75
825:
823:
185:
108:Presence of cerebrovascular risk factors
776:
569:
424:
890:
500:
401:
864:
820:
565:https://doi.org/10.1176/ajp.154.4.562
592:
387:10.1001/archpsyc.1997.01830220033006
118:, decrease in processing speed, and
157:However, there is some evidence of
13:
14:
909:
518:Revista Brasileira de Psiquiatria
233:transcranial magnetic stimulation
881:https://doi.org/10.1002/gps.1172
545:
719:
664:
531:10.1590/S1516-44462011000400015
52:subcortical ischemic depression
17:Subcortical ischemic depression
831:Archives of General Psychiatry
732:Journal of Affective Disorders
689:10.1016/j.biopsych.2003.08.014
609:
561:American Journal of Psychiatry
461:
375:Archives of General Psychiatry
251:
1:
289:
222:
41:
7:
10:
914:
277:
48:magnetic resonance imaging
744:10.1016/j.jad.2017.03.004
338:10.1186/s12916-016-0720-5
25:major depressive disorder
181:
284:cerebrovascular disease
85:psychomotor retardation
788:Psychological Medicine
580:Psychological Medicine
231:Keeping this in mind,
209:coronary heart disease
191:
808:Biological Psychiatry
677:Biological Psychiatry
189:
116:executive dysfunction
634:10.1212/wnl.56.7.921
148:late-life depression
563:, 154(4), 562–565.
197:high blood pressure
95:and visual naming.
21:vascular depression
192:
898:Depression (mood)
814:(12), 1299–1303.
201:diabetes mellitus
159:internal validity
74:, or subcortical
905:
883:
868:
862:
847:
841:
827:
818:
804:
795:
783:
774:
773:
763:
723:
717:
716:
668:
662:
661:
613:
607:
596:
590:
576:
567:
557:
551:
550:
549:
543:
533:
509:
498:
497:
465:
459:
458:
439:10.1002/gps.1255
422:
399:
398:
370:
361:
360:
350:
340:
316:
72:hyperintensities
19:, also known as
913:
912:
908:
907:
906:
904:
903:
902:
888:
887:
886:
869:
865:
848:
844:
828:
821:
805:
798:
784:
777:
724:
720:
669:
665:
614:
610:
597:
593:
577:
570:
558:
554:
544:
510:
501:
466:
462:
423:
402:
371:
364:
317:
296:
292:
280:
254:
225:
213:tobacco smoking
184:
139:
44:
12:
11:
5:
911:
901:
900:
885:
884:
879:(9), 833–842.
863:
842:
837:(3), 268–276.
819:
796:
775:
718:
683:(4): 390–397.
663:
628:(7): 921–926.
608:
591:
586:(3), 383–392.
568:
552:
499:
460:
400:
381:(10): 915–22.
362:
293:
291:
288:
279:
276:
253:
250:
224:
221:
205:hyperlipidemia
183:
180:
138:
135:
126:
125:
122:
112:
109:
106:
103:
43:
40:
9:
6:
4:
3:
2:
910:
899:
896:
895:
893:
882:
878:
874:
867:
861:
857:
853:
846:
840:
836:
832:
826:
824:
817:
813:
809:
803:
801:
793:
789:
782:
780:
771:
767:
762:
757:
753:
749:
745:
741:
737:
733:
729:
722:
714:
710:
706:
702:
698:
694:
690:
686:
682:
678:
674:
667:
659:
655:
651:
647:
643:
639:
635:
631:
627:
623:
619:
612:
606:(3), 248–253.
605:
601:
595:
589:
585:
581:
575:
573:
566:
562:
556:
548:
541:
537:
532:
527:
523:
519:
515:
508:
506:
504:
495:
491:
487:
483:
480:(1): 98–106.
479:
475:
471:
464:
456:
452:
448:
444:
440:
436:
432:
428:
421:
419:
417:
415:
413:
411:
409:
407:
405:
396:
392:
388:
384:
380:
376:
369:
367:
358:
354:
349:
344:
339:
334:
330:
327:(Editorial).
326:
322:
315:
313:
311:
309:
307:
305:
303:
301:
299:
294:
287:
285:
275:
271:
267:
264:
260:
249:
246:
245:carotid stent
242:
238:
234:
229:
220:
216:
214:
210:
206:
202:
198:
188:
179:
176:
171:
169:
165:
160:
155:
153:
149:
145:
134:
132:
123:
121:
117:
113:
110:
107:
104:
101:
100:
99:
96:
94:
90:
86:
80:
77:
73:
69:
64:
61:
57:
53:
49:
39:
37:
32:
30:
26:
22:
18:
876:
872:
866:
858:(1), 75–84.
855:
851:
845:
834:
830:
811:
807:
794:, 1015–1026.
791:
787:
735:
731:
721:
680:
676:
666:
625:
621:
611:
603:
599:
594:
583:
579:
560:
555:
524:(4): 400–9.
521:
517:
477:
473:
463:
430:
426:
378:
374:
328:
325:BMC Medicine
324:
281:
272:
268:
262:
258:
255:
230:
226:
217:
193:
172:
164:hypertension
156:
140:
130:
127:
97:
81:
68:white matter
65:
59:
51:
45:
33:
20:
16:
15:
433:(1): 1–11.
252:Controversy
144:post-stroke
76:grey matter
331:(1): 161.
290:References
241:citalopram
237:nimodipine
223:Management
36:depression
752:1573-2517
738:: 60–66.
697:0006-3223
642:0028-3878
622:Neurology
486:1064-7481
131:necessary
42:Diagnosis
892:Category
770:28284097
713:29802787
705:14960292
658:25407657
650:11294930
540:22189931
494:11790640
455:19083813
447:15578670
357:27806704
263:required
152:etiology
120:lethargy
89:paranoia
29:ischemia
761:5405441
395:9337771
348:5093970
278:History
235:(TMS),
168:fatigue
93:fluency
56:lesions
768:
758:
750:
711:
703:
695:
656:
648:
640:
538:
492:
484:
453:
445:
393:
355:
345:
259:enough
243:, and
211:, and
175:apathy
709:S2CID
654:S2CID
451:S2CID
182:Cause
766:PMID
748:ISSN
701:PMID
693:ISSN
646:PMID
638:ISSN
536:PMID
490:PMID
482:ISSN
443:PMID
391:PMID
353:PMID
756:PMC
740:doi
736:214
685:doi
630:doi
526:doi
435:doi
383:doi
343:PMC
333:doi
146:or
894::
877:19
875:,
856:22
854:,
835:65
833:,
822:^
812:60
810:,
799:^
792:28
790:,
778:^
764:.
754:.
746:.
734:.
730:.
707:.
699:.
691:.
681:55
679:.
675:.
652:.
644:.
636:.
626:56
624:.
620:.
604:82
602:,
584:37
582:,
571:^
534:.
522:33
520:.
516:.
502:^
488:.
478:10
476:.
472:.
449:.
441:.
431:20
429:.
403:^
389:.
379:54
377:.
365:^
351:.
341:.
329:14
323:.
297:^
239:,
207:,
203:,
199:,
170:.
154:.
87:,
772:.
742::
715:.
687::
660:.
632::
542:.
528::
496:.
457:.
437::
397:.
385::
359:.
335::
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
