The Effect of White Matter Hyperintensity Burden on Antidepressant Treatment Remission: A Meta-Analysis

Depression is a common problem among older adults and is further exacerbated by poor antidepressant treatment response and remission. The vascular depression hypothesis suggests that cerebrovascular disease and executive dysfunction are main contributors to treatment nonresponse in older adults. While a previous meta-analysis has demonstrated the effects of executive dysfunction on treatment response, similar techniques have not been used to address the relationship between cerebrovascular disease and treatment response or remission. The purpose of this meta-analysis was to rigorously evaluate well-controlled antidepressant treatment trials to determine the relationship between cerebrovascular disease and antidepressant treatment remission.

A MEDLINE search was conducted to identify regimented antidepressant treatment trials contrasting white matter hyperintensity (WMH) burden between remitters and nonremitters. Regimented treatment trials for depressed outpatients aged 50 and older that had a pretreatment measure of WMH burden and remitter/nonremitter comparison were included. Log odds ratio (LOR) was calculated for each trial's treatment effect. A Bayesian meta-analysis was used to estimate an aggregate effect size.

Seven studies met inclusion criteria. There was a significant, negative effect of WMH burden on antidepressant remission status (LOR = -0.62, 95% CI: -1.14, -0.14; z = -2.48, p = 0.013).

Depressed older adults with high cerebrovascular burden are 35% less likely to remit compared to depressed older adults with low or no levels of cerebrovascular disease. Results suggest that it may be important to consider vascular depression as a distinct treatment target of alternate interventions.