Effect of cerebrovascular risk factors on depression treatment outcome in later life.
OBJECTIVE
The vascular depression hypothesis posits that depression can arise in late life from cerebrovascular damage and that depression arising this way has a different clinical presentation and is more chronic and treatment-resistant than early-onset depression. This study tested the relationship of cerebrovascular risk factors (CVRF) to clinical presentation and treatment outcome in 156 subjects enrolled in a long-term maintenance treatment study of late-life recurrent major depression.


METHODS
CVRF scores were generated with the Probability of Stroke Risk Profile. Subjects with the highest one-third of scores were designated High CVRF, and their baseline clinical presentation and treatment outcomes were compared with the remaining subjects.


RESULTS
In the High-CVRF group, a greater proportion of subjects had first-onset depression after age 60. However, high CVRF score, late onset of depression, and their interaction had no effect on time-to-remission, need for adjunctive medication, or increased risk for recurrence during 3-year follow-up. Furthermore, high CVRF score and late onset of depression did not predict the associated clinical features of vascular depression, such as psychomotor retardation and lack of insight, previously described in the literature.


CONCLUSIONS
Optimism about the outcome of late-life depression treatment should not be diminished by the presence of high cerebrovascular risk.
Miller
Mark D
MD
Intervention Research Center in Late-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. millermd@msx.upmc.edu
Lenze
Eric J
EJ
Dew
Mary Amanda
MA
Whyte
Ellen
E
Weber
Elizabeth
E
Begley
Amy E
AE
Reynolds
Charles F
CF
D017668:Age of Onset; D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D002561:Cerebrovascular Disorders / Q000523:psychology*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D009661:Nortriptyline / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic; D009661:Nortriptyline