The heart and brain connection: Contribution of cardiovascular disease to vascular depression – A narrative review

The relationship between depression and cardiovascular disease (CVD) is bidirectional. Depression is a risk factor for developing CVD, and this, together with vascular risk factors (VascRFs), increases vulnerability to precipitate some types of geriatric depression (vascular depression). The particular semiology of depression of vascular origin (polymorphic), the symptoms of the comorbidities (vascular disease and/or risk factors), and those symptoms of old age constitute a challenge for clinical medicine. Although the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth/Fifth Edition do not differentiate between early-onset (young adult) and late-onset depression (older adult), the clinical expression of patients with depression of vascular origin presents its own characteristics as well as a poor response to treatment. Thus, cerebrovascular disease could be considered the link between VascRFs and the clinical expression of mood disorders (vascular depression), creating a challenge not only in its diagnosis but also in its treatment.