drug-Resistant Major depression Associated With Carotid Artery stenosis

hAM-d score was 5. No depressive relapse had occurred 8 weeks later.A mood disorder due to a general medical condition (carotid artery stenosis) with major depressive-like epi-sode was diagnosed.Even if age and an asymptomatic left parietal infarct could be considered predisposing factors for depression (1), three factors suggest that major depression was related to severe carotid artery stenosis in this case: no familial or personal psychiatric history, full recovery within 4 days of carotid end-arterectomy (a time course atypical for recovery from idio-pathic major depression), and absence of relapse 8 weeks af-ter carotid endarterectomy. Moreover, carotid artery stenosis has been associated with depressive symptoms and suicide in two previous case reports, even in the absence of cerebral in-farction (2, 3), and cerebral hypoperfusion was the suspected underlying mechanism. Indeed, our report is consistent with a previous case showing a positive effect of carotid endarter-ectomy on major depression (2).Consequently, in patients with cardiovascular risk factors, and even if carotid bruit is not present, drug-resistant major depression requires systematic carotid Doppler ultrasonogra-phy as early as possible to screen for carotid artery stenosis, since carotid endarterectomy can produce rapid and full re-covery of carotid artery stenosis-related drug-resistant major depression.References1. Flicker L: Vascular factors in geriatric psychiatry: time to take a serious look. Curr Opin Psychiatry 2008; 21:551–5542. Coumans JV, McGrail KM: Psychiatric presentation of carotid stenosis. Surgery 2000; 127:713–7153. Lovett JK, Rothwell PM: Suicide in a patient with symptomatic carotid occlusion. J R Soc Med 2002; 95:93–94FLORENcE GRESSIER, M.D.hEDI KhLIF, M.D.chRISTIAN DENIER, M.D., P