BMJ 1999;318:737 ( 13 March )

Letters

Severe deep white matter lesions and outcome in major depressive disorder

    Might vasculitis be cause of these lesions in elderly depressive patients?
    Further investigation of deep white matter lesions is necessary

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

The first 150 words of the full text of this article appear below.

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 nervous system.

There is a good chance that the deep white matter lesions described by O'Brien et al represent localised vasculitis in the central nervous system. As patients with these lesions had a poor outcome, . . . [Full text of this article]
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Relevant Article

Severe deep white matter lesions and outcome in elderly patients with major depressive disorder: follow up study
John O'Brien, David Ames, Edmond Chiu, Isaac Schweitzer, Patricia Desmond, and Brian Tress
BMJ 1998 317: 982-984. [Abstract] [Full Text] [PDF]

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