Is vascular depression a distinct sub-type of depressive disorder? A review of causal evidence

Abstract

Vascular depression provides a useful framework with which to remind the clinician of important interactions between depression and vascular disease but conceptually it may be too restrictive.

Cerebrovascular Damage in Late-Life Depression Is Associated With Structural and Functional Abnormalities of Subcutaneous Small Arteries

“…This is at odds with the majority of studies in this area, 34 but our findings are not unprecedented 35,36 and are in keeping with a general trend to analyze white matter damage using automated functions 37 or VRS scores. Excessive VRSs in the basal ganglia are associated with treatment resistance in late-onset depression, 7 vascular dementia, 18 and asymptomatic subjects at risk of stroke, 9 and in these studies the amount of dilated VRSs predicted diagnosis (depression or stroke) better than WML scores.…”

Abnormalities of CSF flow patterns in the cerebral aqueduct in treatment‐resistant late‐life depression: A potential biomarker of microvascular angiopathy

“…To our knowledge, this is the first study to describe changes that may reflect MVA in older patients with affective disorder. This is relevant because of the high rate of treatment failure with antidepressants, despite the availability of a range of new drugs (12), and the possibility that treatment with neuroprotective agents may improve the prognosis (37). Randomized controlled trials of antihypertensives have shown a reduction in fatal or nonfatal strokes, and effective treatment of hypertension also appears to reduce the risk of dementia, including Alzheimer's disease (34).…”

“…Low-to moderate-grade MVA is increasingly thought to be important in several geriatric neuropsychiatric syndromes, including very common disorders that are difficult to treat, such as vascular dementia, Alzheimer's disease, and major depressive disorder (11,12). In late-life depressive disorder there is a high rate of T 2 -weighted hyperintensities in the deep WM and basal ganglia in older depressed patients compared to control subjects (11,13), especially where depression onset occurs after 55 years of age (14).…”

“…Late-life depressive disorder associated with WM hyperintensities and/or basal ganglia imaging abnormalities is increasingly being referred to as "vascular depression" (14). A link with MVA is suggested by indirect evidence, such as an association with vascular risk factors (12) and a link between lower vasomotor reactivity in the middle cerebral artery (assessed using CO 2 inhalation) and depression in later life (15), along with direct neuropathological evidence of vascular damage (16). Importantly, the presence of MRI-visualized hyperintensities in late-life depression is associated with a poor response to antidepressant treatment, and it is believed that treatment resistance represents a direct effect of MVA (17)(18)(19)(20).…”

Therapeutic interventions for vascular depression: a systematic review

“…This is also critical for clinical practice, as both conditions (depression and cerebrovascular disorders) are becoming more prevalent with the ageing population. Nevertheless, although previous (systematic and comprehensive) reviews evaluated construct validity, 14 biological plausibility, 1 causality, 15 neuroimaging findings 16 and discriminant validity, 17 none, to the best of our knowledge, scrutinized the VaD concept for interventional studies. Therefore, we systematically reviewed all studies proposing therapeutic interventions for VaD.…”