Vascular Depression and Poststroke Depression: Where Do We Go From Here?

Abstract

This issue of the Journal contains four papers that focus on the topic of poststroke depression or vascular depression. To summarize the papers briefly: The review paper by Kales et al. 1 Kales HC Maixner DF Mellow AF Cerebrovascular disease and late-life depression. Am J Geriatr Psychiatry. 2005; 13: 88-98 Google Scholar compares findings in poststroke depression, including treatment and prevention trials, and vascular depression, where issues about risk factors, clinical picture, prognosis for development of dementia, and new treatment approaches are discussed. Bozikas et al. 2 Bozikas VP Gold G Kövari E et al. Pathological correlates of poststroke depression in elderly patients. Am J Geriatr Psychiatry. 2005; 13: 166-169 Google Scholar compared lesion findings based on autopsies for 21 patients with poststroke depression versus 74 patients without depressive disorder. The major finding was that patients with poststroke depression had died at a significantly earlier age (79.8 years [SD: 5.8]) than nondepressed patients (85.3 years [SD: 6.3]; p = 0.002). Vataja et al. 3 Vataja R Pohjasvaara T Mäntylä R et al. Depression–executive dysfunction syndrome in stroke patients. Am J Geriatr Psychiatry. 2005; 13: 99-107 Google Scholar examined the depressive-executive dysfunction syndrome (DES) in stroke patients, using their cross-sectional study comparing patients with DES and those with executive dysfunction without depression, depression without executive dysfunction, and neither disorder (a classical 2 × 2 study design). The main finding was that, according to logistic-regression analysis, lesions of the frontal-subcortical circuit in the left hemisphere were independently associated with DES. Finally, the paper by Spalletta et al. 4 Spalletta G Ripa A Caltagirone C Symptom profile of DSM-IV major and minor depressive disorders in first-ever stroke patients. Am J Geriatr Psychiatry. 2005; 13: 108-115 Google Scholar examined the symptoms of major depression in 200 patients with first-ever stroke and demonstrated that all vegetative symptoms and most of the psychological symptoms of depression (except guilt feelings) were more common in patients with major depression or minor depression compared with the nondepressed patients.