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Cerebrovascular Reactivity in Major Depression: A Pilot Study

CITATION:  Peter Neu, MD, Peter Schlattmann, MD, MSc, Andreas Schilling, MD and Andreas Hartmann, MD Cerebrovascular Reactivity in Major Depression: A Pilot Study. Psychiatrie und Psychotherapie, Eschenallee 3, 14050 


Objective: There are a growing number of reports that depression may increase the risk of stroke. Little is known, however, about the pathophysiologic mechanisms underlying this association. Cerebrovascular reactivity (CVR) reflects the compensatory dilatory capacity of cerebral arterioles to a dilatory stimulus and is an important mechanism to provide constant cerebral blood flow. We hypothesized that CVR is reduced in patients with major depression, thus contributing to the association between depression and stroke. 

Methods: We assessed CVR in 33 patients with unipolar depression and 26 healthy controls by calculating the increase in cerebral blood flow velocity after stimulation with acetazolamide. Blood flow velocities were measured by transcranial Doppler ultrasound. 

Results: Cerebrovascular reactivity was significantly reduced in depressed patients. Smoking was also associated with a significant reduction in CVR, whereas age and gender had no significant influence. 

Conclusions: Cerebrovascular reactivity appears to be impaired in major depression. Further studies should clarify the mechanisms leading to this reduced CVR. 


Jonas BS, Mussolino ME. Symptoms of depression as a prospective risk factor for stroke. Psychosom Med 2000; 62: 463–71.[Abstract/Free Full Text] 

Larson SL, Owens P, Ford D, Eaton W. Depressive disorder, dysthymia, and risk of stroke: thirteen-year follow-up from the Baltimore epidemiologic catchment area study. Stroke 2001; 32: 1979–83.[Abstract/Free Full Text] 

Ohira T, Iso H, Satoh S, Sankai T, Tanigawa T, Ogawa Y, Imano H, Sato S, Kitamura A, Shimamoto T. Prospective study of depressive symptoms and risk of stroke among Japanese. Stroke 2001; 32: 903–8.[Abstract/Free Full Text] 

Everson SA, Roberts RE, Goldberg DE, Kaplan GA. Depressive symptoms and increased risk of stroke mortality over a 29 year period. Arch Intern Med 1998; 158: 1133–8.[Abstract/Free Full Text] 

Simonsick EM, Wallace RB, Blazer DG, Berkman LF. Depressive symptomatology and hypertension-associated morbidity and mortality in older adults. Psychosom Med 1995; 57: 427–35.[Abstract] 

Fulesdi B, Limburg M, Bereczki C, Michels RP, Neuwirth G, Legemate D, Valikovics A, Csiba L. Impairment of cerebrovascular reactivity in long-term type 1 diabetes. Diabetes 1997; 46: 1840–5.[Abstract] 

Troisi E, Attanasio A, Matteis M, Bragoni M, Monaldo BC, Caltagitone C, Silvestrini M. Cerebral hemodynamics in young hypertensive subjects and effects of atenolol treatment. J Neurol Sci 1998; 159: 115–9.[CrossRef][Medline] 

Yonas H, Smith HA, Durham SR, Pentheny SL, Johnson DW. Increased stroke risk predicted by compromised cerebral blood flow reactivity. J Neurosurg 1993; 79: 483–9.[Medline] 

Silvestrini M, Troisi E, Matteis M, Cupini LM, Caltagirone C. Transcranial doppler assessment of cerebrovascular reactivity in symptomatic and asymptomatic severe carotid stenosis. Stroke 1996; 27: 1970–3.[Abstract/Free Full Text] 

Dahl A, Lindegaard K-F, Russell D, Nyberg-Hansen R, Rootwelt K, Nornes H. A comparison of transcranial Doppler and cerebral blood flow studies to assess cerebral vasoreactivity. Stroke 1992; 23: 15–9.[Abstract]

First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I): Administration Booklet. Washington, DC: American Press; 1997. 

Hamilton M. Rating depressive patients. J Clin Psychiatry 1980; 41: 21–4.[Medline] 

Dahl A, Russell D, Rootwelt K, Nyberg-Hansen R, Kerty E. Cerebral vasoreactivity assessed with transcranial Doppler and regional cerebral blood flow measurements. Stroke 1995; 26: 2302–6.[Abstract/Free Full Text] 

Morioka C, Kondo H, Akashi K, Matsumura K, Ochi N, Furukawa T. The continuous and simultaneous blood flow velocity measurement of four cerebral vessels and a peripheral vessel during cigarette smoking. Psychopharmacology 1997; 131: 220–9.[CrossRef][Medline] 

Breslau N, Kilbey MM, Andreski P. Nicotine withdrawal symptoms and psychiatric disorders: findings from an epidemiologic study of young adults. Am J Psychiatry 1992; 149: 464–9.[Abstract] 

Ungvari Z, Pacher P, Kecskeméti V, Koller A. Fluoxetine dilates small cerebral arteries of rats and attenuates constrictions to serotonin, norepinephrine, and a voltage-dependent Ca 2+ channel opener. Stroke 1999; 30: 1949–58.[Abstract/Free Full Text]