Vascular depression: Where do we go from here?

GGNet Mental Health Center for Old Age Psychiatry, PO Box 928, 7301 BD Apeldoorn, The Netherlands.
Expert Review of Neurotherapeutics (Impact Factor: 2.78). 01/2011; 11(1):77-83. DOI: 10.1586/ern.10.92
Source: PubMed


Vascular depression has been the topic of many studies since its revival at the end of the last century. Several important conclusions can be drawn from this research. First, from a conceptual point of view, it is a potentially valuable eiotological based new entity. Second, vascular depression encompasses not only depression with small vessel disease of the brain, but also poststroke depression, and depression related to myocardial infarction should be placed in this same category of vascular depression. Third, the treatment outcome and natural course of vascular depression have been much worse than that of the nonvascular depression. Fourth, more research on vascular depression is needed, especially on interventions. Poststroke antidepressant and psychoeducation therapy and vascular preventive interventions can probably improve outcome.

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    • "Late-life depression is associated with cognitive impairment, chronic medical illnesses, medication use, and neurodegenerative diseases (Alexopoulos, 2005), characteristics that have a direct impact on physical activity as well as on the phenomenology of the depression. Several studies have pointed to the prolonged course and negative treatment effects in the presence of co-morbid executive dysfunction and co-morbid vascular disease in late-life depression (Naarding and Beekman, 2011; Alexopoulos and Kelly, 2009). These differences are clinically relevant, as a recent study found that 'negative symptoms' of depression – such as loss of interest, diminished activity, and indecisiveness – predict poor outcome of antidepressant treatment and require a more multidisciplinary approach with additional treatment strategies such as behavioral activation and exercise (Uher et al., 2011). "
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    ABSTRACT: Background Knowledge about characteristics explaining low level of physical activity in late-life depression is needed to develop specific interventions aimed at improving physical health in depressed people above the age of 60. Methods This cross-sectional study used data from the Netherlands Study of Depression in Older Persons (NESDO), a longitudinal multi-site naturalistic cohort study. People aged 60 and over with current depression and a non-depressed comparison group were included, and total amount of PA per week was assessed with the short version of the International Physical Activity Questionnaire (IPAQ). Depression characteristics, socio-demographics, cognitive function, somatic condition, psycho-social, environment and other lifestyle factors were added in a multiple regression analysis. Results Depressed persons >60 y were less physically active in comparison with non-depressed subjects. The difference was determined by somatic condition (especially, functional limitations) and by psychosocial characteristics (especially sense of mastery). Within the depressed subgroup only, a lower degree of physical activity was associated with more functional limitations, being an inpatient, and the use of more medication, but not with the severity of the depression. Limitation This study is based on cross-sectional data, so no conclusions can be drawn regarding causality. Conclusions This study confirms that depression in people over 60 is associated with lower physical activity. Patient characteristics seem more important than the depression diagnosis itself or the severity of depression. Interventions aimed at improving physical activity in depressed persons aged 60 and over should take these characteristics into account.
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