Structural brain abnormalities in unselected in-patients with major depression

Objective: Several studies have indicated an increased frequency of cerebra l atrophy and white matter lesions in patients with major depression, espec ially in older age groups. Method: Forty-four representative in-patients with major depression in whic h neurological disorders were clinically excluded, and 49 age- and gender-m atched controls were MR scanned. Results: Unexpectedly, two of the patients had severe brain pathology which could account for their psychiatric symptoms. Analysis of the remaining pa tients (mean age 42 years) did not reveal an increased frequency of cerebra l atrophy. The number of white matter lesions increased with age to an odds ratio greater than 3 for patients aged 50, but this was not statistically significant. Conclusion: Brain atrophy and white matter lesions did not occur with signi ficantly increased frequency in these relatively young unselected depressiv es, but the finding of severe brain pathology stresses the importance of br ain imaging in late-onset psychiatric disorders.