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 Damage to the microvascular system - often caused by high blood
pressure or diabetes, and made worse by smoking - is tied to an
increased risk of depression among people age 40 years and older,
researchers found.
"Be aware that your hypertension and diabetes are an enemy to your
microvascular circulation," said senior author Miranda Schram of
Maastricht University Medical Center in the Netherlands. "Try to
treat them."
The body's very small blood vessels, or capillaries, "are
responsible for taking the oxygen and nutrients to the tissues," she
said. "You can imagine if something goes wrong, the tissue isn’t
happy."
The brain, Schram noted, is "quite vulnerable to these microvascular
changes, because the tissue in the brain is really demanding and
requires a lot of oxygen to work properly."
Problems with these small blood vessels can also affect the eyes,
the nerves, the skin and the kidneys.
To see if there is a link between depression and damage to
capillaries, the researchers searched for existing studies of the
two conditions that included people at least 40 years old.
Altogether, they had data on 43,600 individuals, including 9,203
with depression.
Depending on how microvascular dysfunction was measured in the
various studies, it increased the risk of depression by up to 58
percent, according to a report in JAMA Psychiatry.
For example, when signs of injury to small vessels was detected in
the blood, the risk of depression was 58 percent higher than when
blood tests didn't suggest damage.
People had a 30 percent higher risk of depression when magnetic
resonance imaging (MRI) revealed very small strokes in the brain
caused by failure of these tiny vessels.
The theory is that this blood vessel damage disrupts communication
in areas of the brain important for mood control, said Schram.
"You can imagine that this would lead to a depressed mood," she
added.
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Dr. Bret Rutherford of the New York State Psychiatric Institute and
the Columbia University Department of Psychiatry in New York City
told Reuters Health that while the new study is strong, it can't
prove microvascular dysfunction causes depression later in life.
"The relationships between healthy brain aging and neuropsychiatric
disorders goes in both directions and is sort of complicated," said
Rutherford, who was not involved in the new study.
For example, it could be that microvascular damage causes
depression. Or, it could be that depression leads to unhealthy blood
vessels.
Rutherford said researchers first linked depression to blood vessel
damage in the 1990s, but advances in treatment have been limited and
mainly focused on preventing poor vascular health.
"We certainly have reason to be very rigorous in our treatment of
cardiovascular aging to promote healthy brain aging and to prevent
these types of problems later on," he said.
Also, he said, it's important to treat mental health issues early in
life to prevent cardiovascular issues later on.
SOURCE: http://bit.ly/2qFYTM0 JAMA Psychiatry, online May 31, 2017.
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