Research report
Depression and vascular disease: what is the relationship?

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Abstract

Background: the ‘vascular depression’ hypothesis proposes that vascular disease predisposes to, precipitates or perpetuates depression, and this proposal has stimulated further research into the relationship of depression to vascular disease. Methods: We investigated the nature of the relationship between depression and vascular diseases by reviewing epidemiological, clinical, neuroimaging and neuropathology studies which have reported on the relationship of depression to coronary artery disease, stroke disease, alterations in blood pressure, vascular dementia, diabetes mellitus and cholesterol levels and by reviewing potential mechanisms by which depression could be associated with vascular diseases. Results: there is abundant and increasing evidence from these different lines of research that depression has a bidirectional association with vascular diseases and plausible mechanisms exist which explain how depression might increase these vascular diseases and vice versa. Limitations: this was not a systematic review and so not every report of relevance has been included. Conclusions: depression has a clear bidirectional relationship with vascular diseases. Further study is needed to clarify the mechanisms involved and to investigate the benefits of conventional and novel treatments for vascular diseases in depressive illness.

Section snippets

Depression and vascular disease: what is the relationship?

There has been great interest in the relationship of depressive illness to vascular disease, although the idea has a long history, with Post (1972) observing that many elderly people with depression showed evidence of associated vascular disease. The term ‘vascular depression’ was proposed by Alexopoulos et al. (1997) who suggested it should cover a range of late-life depressive syndromes due to a variety of potential vascular mechanisms. Krishnan et al. (1997) agreed to adopt this terminology,

Studies examining vascular disease in pre-existing depression

Three kinds of study (clinical, neuroimaging and neuropathology) have investigated whether vascular disease, especially cerebrovascular disease, is increased in people with depression.

Studies of depression in pre-existing vascular disease

Many studies have demonstrated an increase in the prevalence of depression in vascular diseases, especially coronary artery disease (CAD) and stroke disease.

Prospective studies of vascular disease and depression

Several prospective studies have examined the impact of depression at baseline on the development of subsequent vascular disease. These reports will be briefly reviewed to examine the relationship between CAD, stroke disease and blood pressure; there appear to be no studies for vascular dementia.

Conclusion

There is convincing evidence from a variety of studies demonstrating that depression and vascular disease are intimately related, especially in the elderly. Vascular disease is increased in depression, vascular diseases are associated with an increased prevalence of depressive illness and depression in an independent risk factor for CAD and stroke. This relationship appears most likely to be bi-directional and there are plausible mechanisms which can explain it in both directions. The concept

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