VASCULAR DEPRESSION HYPOTHESIS

We propose that cerebrovascular disease may predispose, precipitate, o r perpetuate some geriatric depressive syndromes. The ''vascular depre ssion'' hypothesis is supported by the comorbidity of depression, vasc ular disease, and vascular risk factors and the association of ischemi c lesions to distinctive behavioral symptoms. Disruption of prefrontal systems or their modulating pathways by single lesions or by an accum ulation of lesions exceeding a threshold are hypothesized to be centra l mechanisms in vascular depression. The vascular depression concept c an generate studies of clinical and heuristic value. Drugs used for th e prevention and treatment of cerebrovascular disease may be shown to reduce the risk for vascular depression or improve its outcomes. The c hoice of antidepressants in vascular depression may depend on their ef fect on neurologic recovery from ischemic lesions. Research can clarif y the pathways to vascular depression by focusing on the site of the l esion, the resultant brain dysfunction, the presentation of depression and time of onset, and the contribution of nonbiological factors.