How to Treat Vascular Depression?
Disorder linked to blood vessel problems may require new options

(HealthDay News) -- A newer type of depression, associated with a loss of blood to the brain, may require a new type of therapy, research has suggested.

The illness, called vascular depression, tends to occur in people older than 60 and is thought to be related to problems with the blood vessels.

"Mental health practitioners and patients should be aware of the relationship between vascular problems and depression, and should understand the value of preventing vascular changes that might lead to difficult-to-treat depressions, for example, through early recognition and treatment of high blood pressure," Dr. John Newcomer, of Washington University in St. Louis, said in a prepared statement.

The American Academy of Family Physicians recommends that anyone who experiences depressive symptoms for more than two weeks should be evaluated for depression. Symptoms include a loss of pleasure in activities once enjoyed, feeling sad or numb, feeling restless or worthless, constant fatigue and thoughts of suicide.

Various researchers reported their findings on vascular depression at National Institute of Mental Health symposiums during an American Psychiatric Association annual meeting.

One team found that people with major depression who had abnormalities in their frontal lobes were less likely to respond to standard antidepressant therapies, such as citalopram (Celexa) and escitalopram (Lexapro).

The research led by Dr. George Alexopoulos, of Weill Cornell Medical College in New York , was focused on assessing specific brain abnormalities associated with blood vessel problems, and the affect of certain medications.

Using an MRI technique called diffusion tensor imaging, the researchers found that higher blood pressure readings were linked to tiny white matter abnormalities in people with late-life depression. Those abnormalities were found mainly in the brain's frontal lobes and in subcortical areas. Some of the abnormalities were associated with impairment in specific frontal lobe functions.

"With further refinement, the findings may improve physicians' ability to predict who will fail to respond to antidepressants," Alexopoulos said in a prepared statement. "Such patients may need close follow-up and different treatments, such as psychotherapy or novel medications. Second, our findings can be used in the development of new treatments for those who do not respond to classical antidepressants."

His team is also studying how parts of the frontal lobes are activated when depressed people perform cognitive tasks that activate this area of the brain. Preliminary findings suggest "that depressed older patients cannot activate these frontal lobe parts as efficiently as non-depressed older adults," according to Alexopoulos.

In another study, researchers from the University of Iowa have reported that people with vascular depression showed improvement when treated with an experimental technique called repetitive transcranial magnetic stimulation (rTMS).

Their study included 92 people who had gone through three unsuccessful treatments. For the study, they were given either rTMS treatment or fake treatment, or they were given medication or a placebo.

Remission rates were higher among those treated with rTMS. And, the greater the number of magnetic pulses, the higher the remission rates, the study found.

"These findings suggest that this new method of treatment may be particularly useful for these late-life onset depressions and that even greater response rates might be achieved by utilizing more pulses of magnetic stimulation," Dr. Robert Robinson, a professor of psychiatry, said in a prepared statement.

On the Web

Learn more about depression in older adults from the American Psychological Association

SOURCES: HealthDay News ; U.S. National Institute of Mental Health, news release, May 7, 2008; American Academy of Family Physicians (www.familydoctor.org)
Author: Serena Gordon
Publication Date: May 31, 2009
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