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Published on: May 22, 2019
Cerebral Small Vessel Disease and Depression Among Intracerebral Hemorrhage Survivors
Juan Pablo Castello1,2,3, Marco Pasi1,2,4, Patryk Kubiszewski1,2
1Department of Neurology (J.P.C., M.P., P.K., J.R.A., A.C., C.K., Z.D., K.S., C.D.A., M.E.G., S.M.G., J.R., A.V., A.B.), Massachusetts General Hospital, Boston.
Insights
Cerebral small vessel disease (CSVD) markers on neuroimaging are linked to depression in intracerebral hemorrhage (ICH) survivors. Cerebral amyloid angiopathy-related ICH increases depression risk and reduces antidepressant effectiveness.
Area of Science:
- Neurology
- Radiology
- Psychiatry
Background:
- Intracerebral hemorrhage (ICH) is a manifestation of cerebral small vessel disease (CSVD).
- CSVD imaging findings correlate with depression incidence in the general population.
- Neuroimaging may reveal depression risk in ICH survivors.
Purpose of the Study:
- To determine if CSVD imaging markers are associated with depression risk before and after ICH.
- To investigate the link between CSVD markers and depression remission.
- To assess the impact of CSVD on antidepressant treatment effectiveness.
Main Methods:
- Analysis of a single-center longitudinal ICH study.
- Extraction of neuroimaging markers for CSVD subtype and severity.
- Longitudinal follow-up of ICH survivors for depression outcomes and treatment response.
Main Results:
- CSVD markers are associated with depression risk.
- Cerebral amyloid angiopathy (CAA)-related ICH survivors had higher depression rates pre- and post-ICH.
- CAA-related ICH was linked to lower depression remission rates and reduced antidepressant benefit.
Conclusions:
- CSVD severity is associated with depression diagnosis in ICH survivors.
- CAA-related ICH is linked to increased depression and poorer treatment outcomes compared to hypertensive arteriopathy-related ICH.
Background And Purpose:
Intracerebral hemorrhage (ICH) is an acute manifestation of cerebral small vessel disease (CSVD), usually cerebral amyloid angiopathy or hypertensive arteriopathy. CSVD-related imaging findings are associated with increased depression incidence in the general population. Neuroimaging may, therefore, provide insight on depression risk among ICH survivors. We sought to determine whether CSVD CT and magnetic resonance imaging markers are associated with depression risk (before and after ICH), depression remission, and effectiveness of antidepressant treatment.
Methods:
We analyzed data from the single-center longitudinal ICH study conducted at Massachusetts General Hospital. Participants underwent CT and magnetic resonance imaging imaging and were followed longitudinally. We extracted information for neuroimaging markers of CSVD subtype and severity. Outcomes of interest included pre-ICH depression, new-onset depression after ICH, resolution of depressive symptoms, and response to antidepressant treatment.
Results:
We followed 612 ICH survivors for a median of 47.2 months. Multiple CSVD-related markers were associated with depression risk. Survivors of cerebral amyloid angiopathy-related lobar ICH were more likely to be diagnosed with depression before ICH (odds ratio, 1.68 [95% CI, 1.14-2.48]) and after ICH (sub-hazard ratio, 1.52 [95% CI, 1.12-2.07]), less likely to achieve remission of depressive symptoms (sub-hazard ratio, 0.69 [95% CI, 0.51-0.94]), and to benefit from antidepressant therapy (P=0.041). Cerebral amyloid angiopathy disease burden on magnetic resonance imaging was associated with depression incidence and treatment resistance (interaction P=0.037), whereas hypertensive arteriopathy disease burden was only associated with depression incidence after ICH.
Conclusions:
CSVD severity is associated with depression diagnosis, both before and after ICH. Cerebral amyloid angiopathy-related ICH survivors are more likely to experience depression (both before and after ICH) than patients diagnosed with hypertensive arteriopathy-related ICH, and more likely to report persistent depressive symptoms and display resistance to antidepressant treatment.
