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(Reuters Health) - Both peripheral and cerebral microvascular dysfunction are associated with an increased risk of depression among people age 40 years and older, a meta-analysis has found.
The microvascular system is "responsible for taking the oxygen and nutrients to the tissues. You can imagine if something goes wrong, the tissue isn’t happy," said senior author Miranda Schram of Maastricht University Medical Center in the Netherlands.
The brain, Schram noted, is "quite vulnerable to these microvascular changes, because the tissue in the brain is really demanding and requires a lot of oxygen to work properly."
To see if there is a link between depression and microvascular dysfunction, the researchers searched for existing studies of the two conditions that included people at least 40 years old. Altogether, they had data on 43,600 individuals, including 9,203 with depression.
Depending on how microvascular dysfunction was measured in the various studies, it increased the risk of depression by up to 58 percent, according to a report in JAMA Psychiatry May 31.
Rutherford said researchers first linked depression to blood vessel damage in the 1990s, but advances in treatment have been limited and mainly focused on preventing poor vascular health.
"We certainly have reason to be very rigorous in our treatment of cardiovascular aging to promote healthy brain aging and to prevent these types of problems later on," he said.
Also, he said, it's important to treat mental health issues early in life to prevent cardiovascular issues later on.
One third or more of adults diagnosed with major depression also have symptoms of hypomania or mania. In a paradigm shift, new guidelines suggest that patients with mixed features may gain more benefit from an antipsychotic than from an antidepressant.
In patients suffering from depression with mixed features, antidepressants alone typically don't work. They can actually worsen symptoms and even induce mania or suicidal thoughts. A referral to a psychiatrist may be needed to assist with diagnosis and treatment.
Clinicians are encouraged to think about the possibility of mixed features in all patients with depression. Monitor for signs of psychomotor acceleration. And remember, you won't know unless you ask about symptoms of mania or a family history of bipolar disorder.