Objectives:
1-     To make a review of the literature of the vascular depression hypothesis using a number of important scientific articles.

2-     To highlight a range of critical problems facing the vascular depression hypothesis.

Background:
In 1997, Alexopoulos and co-workers introduced the concept of “vascular depression” (VD) as a subtype of geriatric mood disorder. The vascular depression hypothesis postulated that cerebrovascular disease can predispose, precipitate, or perpetuate a depressive syndrome in older adults.

Materials and Methods:
Non-systematic review of the literature with selection of scientific articles published in the last 22 years (according to their scientific relevance), by searching the Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: vascular depression; late-onset depression; cerebrovascular disease; neuroimaging

Results and Conclusions:
Vascular disease and depression have a reciprocal relationship. There is evidence that vascular disease can lead to depression. Although vascular disease increases the risk of depression, the opposite is also true. However, the hypothesis can generate studies of the epidemiology, clinical presentation, outcomes, pathogenesis, and treatment of a large subgroup of geriatric patients with depression. Throughout the history of the vascular depression hypothesis, a number of researchers have proposed different diagnostic criteria. Lack of consensus on criteria makes it difficult to interpret discrepant findings across studies. 
Vascular depression hypothesis has served the field well in providing research direction. There is empirical evidence that cerebrovascular disease confers vulnerability to a variety of syndromes, including depression, other mood syndromes, and psychosis, but also cognitive impairment and peripheral neurologic signs.

The vascular Depression Hypothesis: 22 years Later