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Vascular depression consensus report - a critical update.

Publication ,  Journal Article
Aizenstein, HJ; Baskys, A; Boldrini, M; Butters, MA; Diniz, BS; Jaiswal, MK; Jellinger, KA; Kruglov, LS; Meshandin, IA; Mijajlovic, MD; Raju, K ...
Published in: BMC Med
November 3, 2016

BACKGROUND: Vascular depression is regarded as a subtype of late-life depression characterized by a distinct clinical presentation and an association with cerebrovascular damage. Although the term is commonly used in research settings, widely accepted diagnostic criteria are lacking and vascular depression is absent from formal psychiatric manuals such as the Diagnostic and Statistical Manual of Mental Disorders, 5th edition - a fact that limits its use in clinical settings. Magnetic resonance imaging (MRI) techniques, showing a variety of cerebrovascular lesions, including extensive white matter hyperintensities, subcortical microvascular lesions, lacunes, and microinfarcts, in patients with late life depression, led to the introduction of the term "MRI-defined vascular depression". DISCUSSION: This diagnosis, based on clinical and MRI findings, suggests that vascular lesions lead to depression by disruption of frontal-subcortical-limbic networks involved in mood regulation. However, despite multiple MRI approaches to shed light on the spatiotemporal structural changes associated with late life depression, the causal relationship between brain changes, related lesions, and late life depression remains controversial. While postmortem studies of elderly persons who died from suicide revealed lacunes, small vessel, and Alzheimer-related pathologies, recent autopsy data challenged the role of these lesions in the pathogenesis of vascular depression. Current data propose that the vascular depression connotation should be reserved for depressed older patients with vascular pathology and evident cerebral involvement. Based on current knowledge, the correlations between intra vitam neuroimaging findings and their postmortem validity as well as the role of peripheral markers of vascular disease in late life depression are discussed. CONCLUSION: The multifold pathogenesis of vascular depression as a possible subtype of late life depression needs further elucidation. There is a need for correlative clinical, intra vitam structural and functional MRI as well as postmortem MRI and neuropathological studies in order to confirm the relationship between clinical symptomatology and changes in specific brain regions related to depression. To elucidate the causal relationship between regional vascular brain changes and vascular depression, animal models could be helpful. Current treatment options include a combination of vasoactive drugs and antidepressants, but the outcomes are still unsatisfying.

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Published In

BMC Med

DOI

EISSN

1741-7015

Publication Date

November 3, 2016

Volume

14

Issue

1

Start / End Page

161

Location

England

Related Subject Headings

  • Male
  • Magnetic Resonance Imaging
  • Humans
  • General & Internal Medicine
  • Diagnostic and Statistical Manual of Mental Disorders
  • Depressive Disorder
  • Consensus
  • Cerebrovascular Disorders
  • Brain
  • Aged
 

Citation

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Aizenstein, H. J., Baskys, A., Boldrini, M., Butters, M. A., Diniz, B. S., Jaiswal, M. K., … Tene, O. (2016). Vascular depression consensus report - a critical update. BMC Med, 14(1), 161. https://doi.org/10.1186/s12916-016-0720-5
Aizenstein, Howard J., Andrius Baskys, Maura Boldrini, Meryl A. Butters, Breno S. Diniz, Manoj Kumar Jaiswal, Kurt A. Jellinger, et al. “Vascular depression consensus report - a critical update.BMC Med 14, no. 1 (November 3, 2016): 161. https://doi.org/10.1186/s12916-016-0720-5.
Aizenstein HJ, Baskys A, Boldrini M, Butters MA, Diniz BS, Jaiswal MK, et al. Vascular depression consensus report - a critical update. BMC Med. 2016 Nov 3;14(1):161.
Aizenstein, Howard J., et al. “Vascular depression consensus report - a critical update.BMC Med, vol. 14, no. 1, Nov. 2016, p. 161. Pubmed, doi:10.1186/s12916-016-0720-5.
Aizenstein HJ, Baskys A, Boldrini M, Butters MA, Diniz BS, Jaiswal MK, Jellinger KA, Kruglov LS, Meshandin IA, Mijajlovic MD, Niklewski G, Pospos S, Raju K, Richter K, Steffens DC, Taylor WD, Tene O. Vascular depression consensus report - a critical update. BMC Med. 2016 Nov 3;14(1):161.
Journal cover image

Published In

BMC Med

DOI

EISSN

1741-7015

Publication Date

November 3, 2016

Volume

14

Issue

1

Start / End Page

161

Location

England

Related Subject Headings

  • Male
  • Magnetic Resonance Imaging
  • Humans
  • General & Internal Medicine
  • Diagnostic and Statistical Manual of Mental Disorders
  • Depressive Disorder
  • Consensus
  • Cerebrovascular Disorders
  • Brain
  • Aged