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Severe deep white matter lesions and outcome in major depressive disorder

BMJ 1999; 318 doi: (Published 13 March 1999) Cite this as: BMJ 1999;318:737

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

  1. Michael Schirmer, Rheumatologist (,
  2. Sandra Fels, Medical student
  1. Department of Internal Medicine, University Hospital, A-6020 Innsbruck, Austria
  2. Manchester Royal Infirmary, Manchester M13 9BX
  3. University of Manchester Medical School, Manchester M13 9PT
  4. Forston Clinic, Herison, Dorchester, Dorset DT2 9TB
  5. Academic Department of Old Age Psychiatry, Withington Hospital, Manchester M20 8LR

    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 …

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