Related Experiment Video

Updated: Aug 10, 2026

Vagus Nerve Stimulation As an Adjunctive Neurostimulation Tool in Treatment-resistant Depression
04:29

Vagus Nerve Stimulation As an Adjunctive Neurostimulation Tool in Treatment-resistant Depression

Published on: January 7, 2019

Treatments for vascular depression in older adults: A systematic review

Bernardo Flôr-Rodrigues1, Sofiene Ben Aissa2, David Miranda1

  • 1Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

International Psychogeriatrics
|August 8, 2026
PubMed

Insights

Evidence for treating vascular depression (VaD) in older adults is limited. While some pharmacological and neuromodulation treatments show promise, more large-scale studies are needed for effective guidelines.

Area of Science:

  • Geriatric Psychiatry
  • Neurology
  • Clinical Pharmacology

Background:

  • Vascular depression (VaD) is a late-life depression subtype linked to cerebrovascular disease, cognitive decline, and poor antidepressant response.
  • It increases dementia risk, yet lacks specific treatment guidelines.
  • Current understanding necessitates a review of available interventions.

Purpose of the Study:

  • To systematically review randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological interventions for VaD in older adults.
  • To assess the clinical efficacy of these treatments.

Main Methods:

  • Systematic search of major databases (MEDLINE, EMBASE, Web of Science) and clinical trial registries.
  • Inclusion of 8 RCTs focusing on late-life VaD patients.
  • Interventions included tandospirone, nimodipine, repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS).

Main Results:

  • Tandospirone augmentation showed faster early symptom improvement in most trials.
  • Nimodipine improved remission and reduced recurrence in some trials.
  • Neuromodulation techniques demonstrated potential antidepressant and cognitive benefits, but evidence quality was low to very low due to study limitations.

Conclusions:

  • Current evidence for VaD treatments is limited and of low certainty.
  • There is a critical need for large, well-designed RCTs.
  • Integrated approaches combining vascular risk management with targeted therapies are recommended.
Abstract

Keywords:
Late-life depressionRandomised controlled trialsSystematic reviewTreatmentsVascular depression

Related Concept Videos

Pharmacodynamics in Geriatric Patients: Effects of Age01:27

Pharmacodynamics in Geriatric Patients: Effects of Age

Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...
Antidepressant Drugs: MAOIs and Other Agents01:23

Antidepressant Drugs: MAOIs and Other Agents

Atypical antidepressants, including bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel), and vilazodone (Viibryd), offer unique mechanisms of action. Bupropion weakly inhibits dopamine and norepinephrine reuptake, aiding depression treatment and smoking cessation, with a low risk of sexual dysfunction. Mirtazapine enhances serotonin and norepinephrine neurotransmission, leading to sedation, increased appetite, and weight gain. As a result, it helps treat...
Alzheimer's Disease: Treatment01:22

Alzheimer's Disease: Treatment

Alzheimer's Disease (AD), a neurodegenerative disorder, is pathologically identified by amyloid plaques and neurofibrillary tangles composed of tau protein. AD pharmacotherapy aims to manage cognitive symptoms, delay disease progression, and treat behavioral symptoms. The treatment is primarily symptomatic and palliative, with no definitive disease-modifying therapy available. Cholinesterase inhibitors, including donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne), are...
Peripheral Artery Disease III: Interprofessional Care01:27

Peripheral Artery Disease III: Interprofessional Care

Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
Drug Dosing: Geriatric Patients01:15

Drug Dosing: Geriatric Patients

Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
Hypertension IV: Drug Therapy and Lifestyle Modifications01:28

Hypertension IV: Drug Therapy and Lifestyle Modifications

Multiple classes of antihypertensive medications are employed in treating hypertension. The most commonly recommended first-line treatments include:Thiazide Diuretics, such as chlorthalidone, increase sodium and water excretion from the body, reducing blood volume and blood pressure.Angiotensin-converting enzyme inhibitors, like lisinopril, block the conversion of angiotensin I to II, a potent vasoconstrictor lowering blood pressure.Angiotensin II Receptor Blockers (ARBs) prevent angiotensin II...