This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (40)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Prognosis/ Outcomes  • Aging/ Geriatrics  • Depression  • Alert me on articles by topic

Warren D. Taylor, MD; David C. Steffens, MD, MHS; James R. MacFall, PhD; Douglas R. McQuoid, BS; Martha E. Payne, MPH, RD; James M. Provenzale, MD; K. Ranga Rama Krishnan, MD

Arch Gen Psychiatry. 2003;60:1090-1096.

Context  White matter hyperintensities (WMHs) are bright foci seen in the parenchyma of the brain on T2-weighted cranial magnetic resonance imaging (MRI) scans and are associated with geriatric depression. Because they are associated with age, they should increase in number and size over time. To our knowledge, this is the first longitudinal, volumetric MRI study of WMHs in depression.

Objective  To determine if WMH progression over 2 years influences depression outcomes.

Design  Over 2 years, depressed subjects received antidepressant treatment according to a naturalistic somatic treatment algorithm designed to offer the best possible treatment to the individual. After the treatment period, depressed subjects were dichotomized based on whether they had reached and sustained remission during this period.

Participants  One hundred thirty-three subjects aged 60 years or older meeting DSM-IV criteria for major depressive disorder.

Measures  Cranial MRI was obtained at baseline and approximately 2 years later. White matter hyperintensity volume was measured in each hemisphere using a semiautomated segmentation process.

Outcomes  Subjects were dichotomized based on achieving or not achieving remission of depressive symptoms, defined as a Montgomery-Åsberg Depression Rating Scale score of 8 or less.

Results  The depressed subgroup that achieved and sustained remission had significantly less increases in WMH volume (11.5%) than did the group that did not achieve or sustain remission (31.6%) (P = .01). In a regression model, greater change in WMH volume was significantly associated with failure to sustain remission (P = .004) even when controlling for baseline depression severity, medical illness severity, age, sex, and race. Education was associated with achieving and sustaining remission (P = .02).

Conclusions  Greater progression of WMH volume is associated with poor outcomes in geriatric depression. Future work is needed to develop means of slowing the rate of WMH progression and to determine whether this will lead to improved depression outcomes in elderly persons.

From the Departments of Psychiatry (Drs Taylor, Steffens, and Krishnan, Mr McQuoid, and Ms Payne) and Radiology (Drs MacFall and Provenzale), Duke University Medical Center, Durham, NC.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

White matter hyperintensities in late life depression: a systematic review
Herrmann et al.
J. Neurol. Neurosurg. Psychiatry 2008;79:619-624.
ABSTRACT | FULL TEXT  

The Brain-Derived Neurotrophic Factor VAL66MET Polymorphism and Cerebral White Matter Hyperintensities in Late-Life Depression
Taylor et al.
AJGP 2008;16:263-271.
ABSTRACT | FULL TEXT  

Antidepressant Treatment and Worsening White Matter on Serial Cranial Magnetic Resonance Imaging in the Elderly: The Cardiovascular Health Study
Steffens et al.
Stroke 2008;39:857-862.
ABSTRACT | FULL TEXT  

Biomarkers in Geriatric Psychiatry
Lenze and Mulsant
AJGP 2007;15:827-831.
FULL TEXT  

White matter changes and late-life depressive symptoms: Longitudinal study
Teodorczuk et al.
Br. J. Psychiatry 2007;191:212-217.
ABSTRACT | FULL TEXT  

Response Inhibition Predicts Poor Antidepressant Treatment Response in Very Old Depressed Patients
Sneed et al.
AJGP 2007;15:553-563.
ABSTRACT | FULL TEXT  

Association of AGTR1 With 18-Month Treatment Outcome in Late-Life Depression
Kondo et al.
AJGP 2007;15:564-572.
ABSTRACT | FULL TEXT  

Widespread Effects of Hyperintense Lesions on Cerebral White Matter Structure
Taylor et al.
Am. J. Roentgenol. 2007;188:1695-1704.
ABSTRACT | FULL TEXT  

Progression of white matter lesions and hemorrhages in cerebral amyloid angiopathy.
Chen et al.
Neurology 2006;67:83-87.
ABSTRACT | FULL TEXT  

Neuropsychological Differences Between Late-Onset and Recurrent Geriatric Major Depression
Rapp et al.
Am. J. Psychiatry 2005;162:691-698.
ABSTRACT | FULL TEXT  

Cerebrovascular Disease and Late-Life Depression
Kales et al.
AJGP 2005;13:88-98.
ABSTRACT | FULL TEXT  

Treatment of Depressive Conditions in Later Life: Real-World Light for Dark (or Dim) Tunnels
Lyness
JAMA 2004;291:1626-1628.
FULL TEXT