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- W1639880470 abstract "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 Behcet’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, with a median survival time of only four months, clinical trials of immunosuppressive treatment would be justified despite lack of a proved pathogenetic mechanism. In severe forms of vasculitis in the central nervous system, regimens of corticosteroids, chlorambucil, and cyclophosphamide are well established.4 Lower doses of immunosuppressants might help to prevent serious side effects in this group of geriatric patients." @default.
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- W1639880470 date "1999-03-13" @default.
- W1639880470 modified "2023-10-16" @default.
- W1639880470 title "Severe deep white matter lesions and outcome in major depressive disorder" @default.
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- W1639880470 doi "https://doi.org/10.1136/bmj.318.7185.737b" @default.
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