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Monday, May 12, 2008

Does Vascular Depression Exist?

Are the recent claims to fame from a SSRI and rTMS correct for treatment of vascular depression or just treatments seeking new markets? I think the latter. rTMS is of dubious efficacy in the treatment of depression and new "me too" SSRI's are struggling for a share.

Vascular depression is in the news, especially due to the latest annual meeting of the American Psychiatric Association in Washington DC. Claim has been made that Several Therapies Show Promise for Vascular Depression meaning a SSRI and rTMS. See also Anxiety Insights.

But does the diagnostic entity of Vascular Depression really exist?

The relationship between vascular disease and depression cannot solely be explained by current established risk factors or the effects of treatment for depression. Other mechanisms must apply, and there is some evidence for common genetic factors.

This is the conclusion of a recent review in the International Journal of Geriatric Psychiatry. The current evidence regarding the relationship between vascular disease such as hypertension, coronary artery disease, and depression cannot be entirely explained by current established risk factors. They think that shared genetic factors between depression and vascular diseases can play some role. This has still to be determined.

What is Vascular Depression (Alexopoulos)
Cerebrovascular disease may predispose, precipitate, or perpetuate some geriatric depressive syndromes. The "vascular depression" hypothesis is supported by the comorbidity of depression, vascular disease, and vascular risk factors and the association of ischemic lesions to distinctive behavioral symptoms. Drugs used for the prevention and treatment of cerebrovascular disease may be shown to reduce the risk for vascular depression or improve its outcomes.

The relationship between cardiovascular disease and depression is a bidirectional relationship.
Just as vascular disease and vascular risk factors are associated with increased rates of depression, so depression has also been shown to be an independent risk factor for cardiovascular and cerebrovascular events.

The relationship between depression and cardiovascular disease is not a simple casual one. The two conditions might also be linked via other mechanisms than risk factors such as genetic factors.

So the notion that cardiovascular disease contributes to the development of depression and vice versa is to simple. The claim that some treatments are more efficacious for vascular depression still remain shaky.

Even a Dutch research group with a strong believe in the concept of vascular depression showed in a recent research for cerebrovascular risk factors and incident of depression in community-dwelling elderly, that only moderate support for the vascular depression hypothesis was found.
Teper, E., O'Brien, J.T. (2008). Vascular factors and depression. International Journal of Geriatric Psychiatry DOI: 10.1002/gps.2020
Luijendijk, H.J., Stricker, B.H., Hofman, A., Witteman, J.C., Tiemeier, H. (2008). Cerebrovascular risk factors and incident depression in community-dwelling elderly. Acta Psychiatrica Scandinavica DOI: 10.1111/j.1600-0447.2008.01189.x

1 comment:

Anonymous said...

This is why I've always thought we need much stricter regulation of drug companies in this country - so as to disincentivize this type of marketing strategy.
Thanks for the insightful post!