Response of Patients With Major Depression and Silent Cerebral Infarction to Antidepressant Drug Therapy, With Emphasis on Central Nervous System Adverse Reactions

Abstract

Background and Purpose We previously found that silent cerebral infarction (SCI) is present in most patients older than 50 years with major depression. The present study was designed to clarify the response to antidepressant pharmacotherapy in patients with major depression associated with SCI. Methods Using clinical charts, we retrospectively studied patients older than 50 years who were admitted for antidepressant drug therapy. Patients with bipolar affective disorder and those with focal neurological symptoms were excluded. All patients underwent magnetic resonance imaging and were classified as SCI-negative or SCI-positive. The SCI-positive group was subclassified into those with moderate SCI (either perforating area or cortical area) (n=15) and those with severe SCI (both perforating and cortical areas) (n=7). Duration of treatment in hospital and the incidence of central nervous system adverse reactions to the antidepressant drugs were compared between the two groups. Results The duration of hospital treatment in patients with severe SCI was significantly longer than in those with moderate SCI ( P <.01). The percentage of patients with adverse central nervous system reactions to antidepressant drugs was significantly higher in the SCI-positive group than in the SCI-negative group ( P <.05). Patients with severe SCI had significantly more adverse reactions than those with moderate SCI ( P <.05). Conclusions Depressed patients with severe SCI required longer hospital treatment and had more drug-related adverse reactions of the central nervous system. These findings suggest that the depression associated with severe SCI may be resistant to treatment.