Subcortical ischemic depression

Vascular depression is typically diagnosed using either magnetic resonance imaging (MRI) or clinically defined criteria.

The most severe lesion in an individual is scored based on predefined criteria and considered in combination with two measures of depressive symptomology.

[1] Alternatively, clinically defined criteria as proposed initially by Alexopoulos and colleagues (1997) includes dimensions of depressive symptoms, disability, and cognitive impairment.

[2][3] Specifically, DED syndrome has been characterized by a loss of interest in activities, psychomotor retardation, paranoia, and cognitive impairment in the domains of language fluency and visual naming.

[4] Aizenstein and colleagues (2016) proposed diagnostic criteria for vascular depression that incorporate elements of both clinical and MRI-definitions.

[3] However, there is some evidence of internal validity of vascular depression which provides initial support for its classification as a unique subtype.

[1] Individuals with vascular depression also tend to have more deficits in self-initiation and concentration, higher cardiac illness burden and cerebrovascular risk factors, cognitive impairment (as associated with the severity of white matter lesions in the brain), and increased treatment resistance.

Two primary mechanisms have been proposed: one associates white matter lesions (attributed to cardiovascular burden) and cerebrovascular risk factors.

Cerebrovascular risk factors for vascular depression include high blood pressure, diabetes mellitus, hyperlipidemia, coronary heart disease, and tobacco smoking.

[medical citation needed] Research has found that white matter lesions are particularly important in predicting future depression.

Keeping this in mind, transcranial magnetic stimulation (TMS), nimodipine, citalopram, and carotid stent placements have been shown to be effective treatments for some individuals with vascular depression.

When participants were compared according to MRI defined vascular depression, there was no difference in antidepressant outcomes between those fitting this definition and those not.