Objective: A review of patients who underwent electroconvulsive therapy (ECT) in a geropsychiatry referral setting represents an “enriched sample” of patients with treatment-resistant depression in which to evaluate the evidence that vascular depression is an important aspect of refractory, late-life depression. Design: Retrospective chart review Materials and Methods: The charts of patients with treatment-resistant depression, defined as those who received ECT on the GeroPsychiatry unit, from January 1, 2001, to December 1, 2002, were reviewed. Data included a characterization of the depressive syndrome; history of stroke, atrial fibrillation, hyperlipidemia, or diabetes; neuroimaging abnormalities; presence of dementia and significant comorbid illness (as measured by the Cumulative Illness Rating Scale). Those patients with late-onset depression (onset at > 50 years) were compared with those whose age at first depression was less than 50 years (early-onset). Results: Fifty-two patients met the inclusion criterion. Thirty-four of the fifty-two patients (66.7%) had late-onset depression. The burden of comorbid illness was similar in both groups. The prevalence of one or more vascular risk factors was 94% in both groups. For the 42 patients who had a recorded CT scan, evidence of vascular insults on neuroimaging was similar in both groups. There was a significantly higher prevalence of dementia (71% vs. 39%, p=0.029) in the group with late onset of depression. Those patients in both groups with stroke or vascular changes on neuroimaging were much more likely to be demented (p=0.037). Conclusions: Vascular insults were found to be frequently associated with late life refractory depression, providing evidence for a distinct clinical entity. Strong association of late-onset depression with concomitant dementia may reflect the burden of vascular insults.
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