This study sought to examine the effects of taking cholesterol-lowering medication on outcomes of depression among older depressed adults. 243 elderly depressed patients were treated using an antidepressant algorithm by a geriatric psychiatrist who administered the Montgomery-Asberg Depression Rating Scale (MADRS) at clinical visits up to six years. We defined remission and relapse as achieving MADRS scores less than 7 and greater than 15, respectively. There were no between-group differences on time to remission. Among 167 remitted patients with follow-up data, 61.4% on cholesterol-lowering medication, and 39.8% not on cholesterol medications experienced a relapse during the follow-up period (p<0.032), and remitted patients taking cholesterol medications relapsed more quickly than did others in adjusted analyses (hazard ratio=1.791, p<0.018). These results add to the literature linking cholesterol and mood, and they support the "vascular depression" hypothesis in geriatric depression. Future studies of depression outcomes in the elderly will need to include serial examination of cholesterol levels.