Ischemic Basis for Deep White Matter Hyperintensities in Major Depression

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Abstract
MAGNETIC resonance (MR) imaging studies examining elderly patients with depression have identified an increase in hyperintensities in the subcortical white and deep gray matter.1,2 White matter hyperintensities (WMHs) have been divided into 2 types: those adjacent to the ventricular system (periventricular hyperintensities [PVHs]) and those separate from the ventricles in the deep white matter (deep white matter hyperintensities [DWMHs]). In depression, the frequency of PVHs appears to be comparable with that in age-matched control subjects, but DWMHs are increased.1,2 Such lesions appear most strongly linked to depression when they involve frontal-subcortical circuits that reciprocally link prefrontal areas (the dorsolateral prefrontal cortex[DLPFC] and the anterior cingulate cortex [ACC]) to the basal ganglia.3