Might vasculitis be cause of these lesions in elderly depressive patients?

EDITOR—The study by O‘Brien et al clearly shows that deep white matter lesions on magnetic resonance imaging are relevant to the outcome in elderly depressed patients.1 It is not only psychiatrists for whom this result is important. Although the authors excluded all patients who had a known history of other diseases, depression with such an organic correlate might be secondary to a distinct disease of the central nervous system.

Neuropathological studies are difficult to perform. Interestingly, deep white matter lesions have also been described in vascular diseases such as systemic lupus erythematosus2 and Behçet's disease.3 Patients with these diseases may present with depressive symptoms, possibly as a correlate of vasculitis in the central …