72; P=0.0005) with lower gastrointestinal, neurological, and endocrinemetabolic disease. After controlling for disability, any depression was associated (X2=5.471; P=0.0193) only with upper

gastrointestinal disease, while major depression was associated (X2=11.909, P=0.0026) with lower gastrointestinal and endocrine-metabolic disease. Higher levels of disability and cardiac disease at the initial assessment were associated with worsening of affective status over a 1-year period. However, after controlling for disability, the association between cardiac disease and worsening depression was no longer significant, and a new association between neurological disease and worsening depression emerged. In contrast, Inhibitors,research,lifescience,medical none of the variables tested was associated with persistence versus improvement over a 1-year period in those who were depressed at their initial assessments. This discussion demonstrates that the specific relationships observed between Inhibitors,research,lifescience,medical mental and physical

health can depend strongly upon the assumptions and methods used in analyses. From a broad and pragmatic perspective, the findings on the baseline associations between depression and endocrine-metabolic disease and between cardiac disease and worsening of depression over a 1-year period are compatible with models suggesting a relationship between depression and vascular risk factors. The findings Inhibitors,research,lifescience,medical on gastrointestinal disease are similar to those found by Zubenko and colleagues in a psychiatric inpatient setting,33 and suggest the Inhibitors,research,lifescience,medical salience of autonomic effects (sec below). More critically, however, the results

of analyses that control for disability emphasize the principle that findings can depend critically upon methodology. Medical illnesses as causes for depression: specific mechanism Vascular mechanisms As summarized by Alexopoulos and colleagues,34 a growing body of recent research has focused on cerebrovascular mechanisms for the onset of late-life depression. This line of investigation began with the empirical findings by Inhibitors,research,lifescience,medical Coffey and others35 that late-life dépressives, most often those with late-onset disease, exhibited Phosphatidylinositol diacylglycerol-lyase an excess of subcortical and deep white matter hyperintensities on magnetic find more resonance imaging (MRI) scans, consistent with the hypothesis that depression in late life could be a manifestation of subclinical cerebrovascular disease. The accumulating findings allowed both Alexopolous and his coworkers36,37 and Krishnan and his colleagues38 to propose that vascular depression may be a specific subtype of latelife depression that could be defined either in terms of MRI findings or the presence of specific medical comorbidities; they also suggested that clinical features associated with vascular depression might include increased anhedonia, psychomotor retardation, and loss of insight, but decreased agitation and guilt.