title: Therapeutic interventions for vascular depression: a systematic review.
abstract: OBJECTIVE
  Vascular depression (VaD) hypothesis supports a bidirectional relationship between cerebrovascular risk factors (CRFs) and depression. We examined whether such concept is appropriate for clinical interventions; i.e., whether treating depressive symptoms has an impact on cerebrovascular risk and vice-versa.
  
  
  METHODS
  Systematic review on interventional studies published from October-1997 to April-2010 on MEDLINE and other databases. Search terms were "depressive disorder" (MeSH), "cerebrovascular disorders" (MeSH), and a batch of highly accurate terms to search for experimental and quasi-experimental trials. We used a structured questionnaire to assess the adequacy of the VaD criteria used for vascular, depression, neuroimaging, and neuropsychological features, as well as the main results of each study.
  
  
  RESULTS
  Of the 357 retrieved studies, 12 met our eligibility criteria. These studies adequately reported depression criterion, moderately reported neuroimaging and neuropsychological criteria, and showed severe flaws in vascular assessment. Efficacy trials suggested that nimodipine, transcranial magnetic stimulation, carotid stent placement, and citalopram were effective for VaD. Exploratory studies suggested that white-matter hyperintensities and global vascular risk are predictors of poor response. Although the low quality of the studies hinders the findings' generalization, studies of higher validity support the VaD concept for interventions.
  
  
  CONCLUSIONS
  VaD seems to be a useful concept for clinical interventions; however, further trials should refine CRFs criteria to assess its impact on antidepressant efficacy.
authors.affiliation: Department of Neurosciences and Behavior, Instituto de Psicologia, Universidade de São Paulo, São Paulo, Brazil. brunoni@usp.br
authors.forename: Andre Russowsky
authors.initials: AR
authors.lastname: Brunoni
authors.forename: Isabela Martins
authors.initials: IM
authors.lastname: Benseñor
authors.forename: Tania Correa de Toledo Ferraz
authors.initials: TC
authors.lastname: Alves
mesh_terms: D002561:Cerebrovascular Disorders / Q000628:therapy*; D002986:Clinical Trials as Topic; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D018401:Sample Size; D016896:Treatment Outcome