Perspectives on the Management of Vascular Depression

Taylor, Warren D.; Schultz, Susan K.; Panaite, Vanessa; Steffens, David C.

doi:10.1176/appi.ajp.2018.18050568

Cited by 13 publications

(15 citation statements)

References 46 publications

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“…These overt differences generated mechanistic hypotheses on the role of vascular and metabolic risk factors and their involvement in the development of LLD [ 23 ]. It was postulated that cerebrovascular damage may contribute to depression in advanced age via involvement of brain regions involved in mood regulation, notably damage to subcortical regions [ 24 ]. “Vascular depression” or “subcortical ischemic depression”, due to lesions in the subcortical white and/or gray matter caused by reduced cerebral blood flow (CBF), were suggested to be particularly relevant in older individuals without a history of previous depressive episodes, i.e., LOD.…”

Section: Introductionmentioning

confidence: 99%

“…VaD encompasses not only depression with cerebral small vessel disease but also post-stroke depression (PSD) and depression related to myocardial infarction and other cardiovascular diseases [ 25 ]. Although depressive symptoms in older adults (around/after age 60 years) are common, about 22% of adults with lifetime MDD meet the criteria for the VaD subtype [ 26 ], the concept of age-related VaD is still not generally accepted and it is not included in current psychiatric manuals as DSM-5 and ICD-10 [ 24 ]. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) defines major depressive disorder by the presence of depressed mood or a marked loss of interest or pleasure in activities along with five or more of the following associated symptoms: changes in appetite or weight (5% of the total body weight), sleep, energy, concentration, and psychomotor activity, feelings of inappropriate guilt or worthlessness, and recurrent thoughts of death or suicide.…”

Section: Introductionmentioning

confidence: 99%

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Pathomechanisms of Vascular Depression in Older Adults

Jellinger¹

2021

IJMS

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Depression in older individuals is a common complex mood disorder with high comorbidity of both psychiatric and physical diseases, associated with high disability, cognitive decline, and increased mortality The factors predicting the risk of late-life depression (LLD) are incompletely understood. The reciprocal relationship of depressive disorder and age- and disease-related processes has generated pathogenic hypotheses and provided various treatment options. The heterogeneity of depression complicates research into the underlying pathogenic cascade, and factors involved in LLD considerably differ from those involved in early life depression. Evidence suggests that a variety of vascular mechanisms, in particular cerebral small vessel disease, generalized microvascular, and endothelial dysfunction, as well as metabolic risk factors, including diabetes, and inflammation that may induce subcortical white and gray matter lesions by compromising fronto–limbic and other important neuronal networks, may contribute to the development of LLD. The “vascular depression” hypothesis postulates that cerebrovascular disease or vascular risk factors can predispose, precipitate, and perpetuate geriatric depression syndromes, based on their comorbidity with cerebrovascular lesions and the frequent development of depression after stroke. Vascular burden is associated with cognitive deficits and a specific form of LLD, vascular depression, which is marked by decreased white matter integrity, executive dysfunction, functional disability, and poorer response to antidepressive therapy than major depressive disorder without vascular risk factors. Other pathogenic factors of LLD, such as neurodegeneration or neuroimmune regulatory dysmechanisms, are briefly discussed. Treatment planning should consider a modest response of LLD to antidepressants, while vascular and metabolic factors may provide promising targets for its successful prevention and treatment. However, their effectiveness needs further investigation, and intervention studies are needed to assess which interventions are appropriate and effective in clinical practice.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pathomechanisms of Vascular Depression in Older Adults

Jellinger¹

2021

IJMS

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“…Vascular-related depression is associated with poor response to current antidepressant treatments (104). In addition, there are no current evidence-based primary prevention pharmacotherapies for late-onset depression.…”

Section: Potential Therapeutic Targets and Interventionsmentioning

confidence: 99%

Microvascular Contribution to Late-Onset Depression: Mechanisms, Current Evidence, Association With Other Brain Diseases, and Therapeutic Perspectives

Empana

Boutouyrie

Lemogne

et al. 2021

Biological Psychiatry

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“… 18 Studies reported that only a third of older patients treated with antidepressants achieved remission, 114 , 115 and individuals with signs of frailty or vascular depression have weaker responses to antidepressants. 115 , 116 As a result, the potential benefits and risks for adverse events related to antidepressant treatments need to be regularly assessed. 117…”

Section: Depression Among Retireesmentioning

confidence: 99%

Spotlight on the Challenges of Depression following Retirement and Opportunities for Interventions

Dang¹,

Ananthasubramaniam²,

Mezuk³

2022

CIA

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As a major life transition characterized by changes in social, behavioral, and psychological domains, retirement is associated with numerous risk factors that can contribute to the development of depression in later life. Understanding how these risk factors intersect with overall health and functioning can inform opportunities for mental health promotion during this transition. The objective of this review is to summarize the literature on risk and protective factors for depression during retirement transitions, discuss challenges related to appropriate management of depression in later life, and describe opportunities for prevention and intervention for depression relating to retirement transitions, both within and beyond the health care system. Key implications from this review are that 1) the relationship between depression and retirement is multifaceted; 2) while depression is a common health condition among older adults, this syndrome should not be considered a normative part of aging or of retirement specifically; 3) the existing mental health specialty workforce is insufficient to meet the depression management needs of the aging population, and 4) therefore, there is a need for interprofessional and multidisciplinary intervention efforts for preventing and managing depression among older adults. In sum, both healthcare providers, public health practitioners, and community organizations have meaningful opportunities for promoting the mental health of older adults during such major life transitions.

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Perspectives on the Management of Vascular Depression

Cited by 13 publications

References 46 publications

Pathomechanisms of Vascular Depression in Older Adults

Pathomechanisms of Vascular Depression in Older Adults

Microvascular Contribution to Late-Onset Depression: Mechanisms, Current Evidence, Association With Other Brain Diseases, and Therapeutic Perspectives

Spotlight on the Challenges of Depression following Retirement and Opportunities for Interventions

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