Depression and vascular disease: what is the relationship?

Background: the 'vascular depression' hypothesis proposes that vascular disease predisposes to, precipitates or perpetuates depression and this proposal has stimulated further research into the relationship of depression to vascular disease. Methods: We investigated the nature of the relationship between depression and vascular diseases by reviewing epidemiological, clinical, neuroimaging and neuropathology studies which have reported on the relationship of depression to coronary artery disease, stroke disease, alterations in blood pressure, vascular dementia, diabetes mellitus and cholesterol levels and by reviewing potential mechanisms by which depression could be associated with vascular diseases. Results: there is abundant and increasing evidence from these different lines of research that depression has a bidirectional association with vascular diseases and plausible mechanisms exist which explain how depression might increase these vascular diseases and vice versa. Limitations: this was not a systematic review and so not every report of relevance has been included. Conclusions: depression has a clear bidirectional relationship with vascular diseases. Further study is needed to clarify the mechanisms involved and to investigate the benefits of conventional and novel treatments for vascular diseases in depressive illness. (C) 2002 Elsevier B.V. All rights reserved.