Vascular depression - A new concise concept?

Many studies pointed out that in the elderly depression is underdiagnosed, probably due to the uncharacteristic psychopathologic symptoms. Often elder people complain about somatic disorders and cognitive impairment, sometime s covering the psychopathologic symptoms and hampering diagnostic classific ation. Cerebrovascular disorders has been considered to be one major cause for depressive mood in the elderly. In a recent paper Alexopoulos et at. (1 997) proposed the concept of vascular depression (VD) which is different fr om that of post-stroke depression established by the group of Robinson and Starkstein. The new concept is critically reviewed with regard of its clini cal feasibility. In contrast to the ICD-10 guidelines the vascular depressi on concept requires no connection between the occurrence of psychopathology and of cerebrovascular disorder. Therefore it appears to be more feasible in clinical practice. However; a differentiation of vascular depression int o two subtypes according to the CT/MRI findings seems to be more promising: type I (macroangiopathy) is similar to post-stroke-depression, while type II is characterized by microangiopathy and its clinical description resembl es that for vascular depression of Alexopoulos et al. Up to now possible th erapeutic consequences have not been investigated. Moreover, the concept of vascular depression basing only on two clinical studies needs further conf irmation.