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Support for the vascular depression hypothesis in late-life depression: results of a 2-site, prospective, antidepressant treatment trial.

Publication ,  Journal Article
Sheline, YI; Pieper, CF; Barch, DM; Welsh-Bohmer, K; McKinstry, RC; MacFall, JR; D'Angelo, G; Garcia, KS; Gersing, K; Wilkins, C; Taylor, W ...
Published in: Arch Gen Psychiatry
March 2010

CONTEXT: Research on vascular depression has used 2 approaches to subtype late-life depression, based on executive dysfunction or white matter hyperintensity severity. OBJECTIVE: To evaluate the relationship of neuropsychological performance and white matter hyperintensity with clinical response in late-life depression. DESIGN: Two-site, prospective, nonrandomized controlled trial. SETTING: Outpatient clinics at Washington University and Duke University. PARTICIPANTS: A total of 217 subjects aged 60 years or older met DSM-IV criteria for major depression, scored 20 or more on the Montgomery-Asberg Depression Rating Scale (MADRS), and received vascular risk factor scores, neuropsychological testing, and magnetic resonance imaging; they were excluded for cognitive impairment or severe medical disorders. Fazekas rating was conducted to grade white matter hyperintensity lesions. Intervention Twelve weeks of sertraline treatment, titrated by clinical response. Main Outcome Measure Participants' MADRS scores over time. RESULTS: Baseline neuropsychological factor scores correlated negatively with baseline Fazekas scores. A mixed model examined effects of predictor variables on MADRS scores over time. Baseline episodic memory (P = .002), language (P = .007), working memory (P = .01), processing speed (P < .001), executive function factor scores (P = .002), and categorical Fazekas ratings (P = .05) predicted MADRS scores, controlling for age, education, age of onset, and race. Controlling for baseline MADRS scores, these factors remained significant predictors of decrease in MADRS scores, except for working memory and Fazekas ratings. Thirty-three percent of subjects achieved remission (MADRS < or =7). Remitters differed from nonremitters in baseline cognitive processing speed, executive function, language, episodic memory, and vascular risk factor scores. CONCLUSIONS: Comprehensive neuropsychological function and white matter hyperintensity severity predicted MADRS scores prospectively over a 12-week treatment course with selective serotonin reuptake inhibitors in late-life depression. Baseline neuropsychological function differentiated remitters from nonremitters and predicted time to remission in a proportional hazards model. Predictor variables correlated highly with vascular risk factor severity. These data support the vascular depression hypothesis and highlight the importance of linking subtypes based on neuropsychological function and white matter integrity. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00045773.

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Published In

Arch Gen Psychiatry

DOI

EISSN

1538-3636

Publication Date

March 2010

Volume

67

Issue

3

Start / End Page

277 / 285

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Severity of Illness Index
  • Sertraline
  • Selective Serotonin Reuptake Inhibitors
  • Psychiatry
  • Psychiatric Status Rating Scales
  • Prospective Studies
  • Proportional Hazards Models
  • Neuropsychological Tests
  • Middle Aged
 

Citation

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Sheline, Y. I., Pieper, C. F., Barch, D. M., Welsh-Bohmer, K., McKinstry, R. C., MacFall, J. R., … Doraiswamy, P. M. (2010). Support for the vascular depression hypothesis in late-life depression: results of a 2-site, prospective, antidepressant treatment trial. Arch Gen Psychiatry, 67(3), 277–285. https://doi.org/10.1001/archgenpsychiatry.2009.204
Sheline, Yvette I., Carl F. Pieper, Deanna M. Barch, Kathleen Welsh-Bohmer, Robert C. McKinstry, James R. MacFall, Gina D’Angelo, et al. “Support for the vascular depression hypothesis in late-life depression: results of a 2-site, prospective, antidepressant treatment trial.Arch Gen Psychiatry 67, no. 3 (March 2010): 277–85. https://doi.org/10.1001/archgenpsychiatry.2009.204.
Sheline YI, Pieper CF, Barch DM, Welsh-Bohmer K, McKinstry RC, MacFall JR, et al. Support for the vascular depression hypothesis in late-life depression: results of a 2-site, prospective, antidepressant treatment trial. Arch Gen Psychiatry. 2010 Mar;67(3):277–85.
Sheline, Yvette I., et al. “Support for the vascular depression hypothesis in late-life depression: results of a 2-site, prospective, antidepressant treatment trial.Arch Gen Psychiatry, vol. 67, no. 3, Mar. 2010, pp. 277–85. Pubmed, doi:10.1001/archgenpsychiatry.2009.204.
Sheline YI, Pieper CF, Barch DM, Welsh-Bohmer K, McKinstry RC, MacFall JR, D’Angelo G, Garcia KS, Gersing K, Wilkins C, Taylor W, Steffens DC, Krishnan RR, Doraiswamy PM. Support for the vascular depression hypothesis in late-life depression: results of a 2-site, prospective, antidepressant treatment trial. Arch Gen Psychiatry. 2010 Mar;67(3):277–285.

Published In

Arch Gen Psychiatry

DOI

EISSN

1538-3636

Publication Date

March 2010

Volume

67

Issue

3

Start / End Page

277 / 285

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Severity of Illness Index
  • Sertraline
  • Selective Serotonin Reuptake Inhibitors
  • Psychiatry
  • Psychiatric Status Rating Scales
  • Prospective Studies
  • Proportional Hazards Models
  • Neuropsychological Tests
  • Middle Aged