Carotid atherosclerosis in depression and anxiety: associations for age of depression onset.

Objective: Mental health and cardiovascular disease have been associated, whereas the temporal course and underlying mechanisms are still incompletely understood. Our aims were to examine the presence of subclinical atherosclerosis in subjects with depressive or anxiety disorder, also taking into account disorder characteristics (subtype, severity, duration, age of onset, medication).

Methods: The sample included 470 depression or anxiety cases and 179 controls, aged 20-66 years, participating in the Netherlands Study of Depression and Anxiety (NESDA). Diagnoses were assigned using the DSM-IV based Composite International Diagnostic Interview. Carotid intima-media thickness (CIMT) and plaque information were obtained using B-mode ultrasound imaging.

Results: Overall, depressive and anxiety disorders were not associated with carotid atherosclerosis. However, age of depression onset was associated with CIMT (total: 0.01 mm per 10 years, P = 0.01; bifurcation: 0.02 mm per 10 years, P = 0.003) and plaque presence (OR = 1.35 per 10 years, 95%CI = 1.02-1.80, P = 0.04). When compared with controls, late-onset (≥ 40 years) depressed had an increased CIMT in the atherosclerosis progression-prone bifurcation segment (0.75 vs. 0.81 mm, P = 0.004).

Conclusions: These findings suggest a distinct pathophysiology of late-onset as compared with early-onset depression, including a vascular component.