Novel Augmentation Therapy with Cilostazol for the Geriatric Major Depressive Disorder Patient with Deep White Matter Hyperintensities on T2-Weighted Brain MRI: A Case Report

BackgroundAn increased incidence of brain white-matter hyperintensities has been described in major depressive disorder, but the impact of such hyperintensities on treatment outcome is still controversial.AimsTo investigate the relationship of brain white-matter hyperintensities with cardiovascular risk factors and with treatment outcome in younger people with major depressive disorder.MethodWe assessed brain white-matter hyperintensities and cardiovascular risk factors in 84 people with major depressive disorder prior to initiating antidepressanttreatment. We also assessed hyperintensities in 35 matched controls.ResultsWe found no significant difference in the prevalence of white-matter hyperintensities between the depression and the control groups. Left-hemisphere subcortical hyperintensities correlated with lower rates of treatment response. We found no correlation between global hyperintensity measures and clinical outcome. Brain white-matter hyperintensities correlated with hypertension and age and with total cardiovascular risk score.ConclusionsSubcortical white-matter hyperintensities in the left hemisphere (but not in other brain areas) may be associated with poor response to antidepressant treatment in major depression.

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White matter hyperintensities and cognitive performance in adult patients with bipolar I, bipolar II, and major depressive disorders

European Psychiatry ◽

10.1016/j.eurpsy.2013.08.002 ◽

2014 ◽

Vol 29 (4) ◽

pp. 226-232 ◽

Cited By ~ 27

Author(s):

T. Kieseppä ◽

R. Mäntylä ◽

A. Tuulio-Henriksson ◽

K. Luoma ◽

O. Mantere ◽

...

Keyword(s):

White Matter ◽

White Matter Hyperintensities ◽

Structural Equation Models ◽

Brain Mri ◽

Path Model ◽

Control Group ◽

Coefficient Estimate ◽

Major Depressive ◽

Brain White Matter ◽

Increased Risk

AbstractPurpose:We evaluate for the first time the associations of brain white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) with neuropsychological variables among middle-aged bipolar I (BPI), II (BPII) and major depressive disorder (MDD) patients and controls using a path model.Methods:Thirteen BPI, 15 BPII, 16 MDD patients, and 21 controls underwent brain MRI and a neuropsychological examination. Two experienced neuroradiologists evaluated WMHs on the MRI scans. We constructed structural equation models to test the strength of the associations between deep WMH (DWMH) grade, neuropsychological performance and diagnostic group.Results:Belonging in the BPI group as opposed to the control group predicted higher DWMH grade (coefficient estimate 1.13, P = 0.012). The DWMH grade independently predicted worse performance on the Visual Span Forward test (coefficient estimate −0.48, P = 0.002). Group effects of BPI and MDD were significant in predicting poorer performance on the Digit Symbol test (coefficient estimate −5.57, P = 0.016 and coefficient estimate −5.66, P = 0.034, respectively).Limitations:Because of the small number of study subjects in groups, the negative results must be considered with caution.Conclusions:Only BPI patients had an increased risk for DWMHs. DWMHs were independently associated with deficits in visual attention.

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