Vascular depression and the death of Queen Victoria.

Overview

OBJECTIVES: The aim of this article was to examine relationships between the neurological events that were the immediate cause of the death of Queen Victoria and the late-life depression that preceded it. METHODS/DESIGN: The authors closely reviewed the surviving medical notes of Queen Victoria's personal physician, Sir James Reid,^Bt. recorded during the Queen's last 10 days of life. These notes were summarized in a chronological narrative and their implications considered in light of current concepts of vascular depression. RESULTS: The depression that Queen Victoria experienced over the 5 months prior to her death and during her final 10 days from 13 January 1901 until 22 January likely had a vascular etiology. CONCLUSIONS: Although conclusions from this study are necessarily speculative given the lack of neuroimaging and other diagnostic tools available in 1901, it emerged that Queen Victoria had experienced early-onset depression followed in later life by an acute depressive episode associated with vascular risk factors and personal losses, a sequence also encountered by today's geriatricians. In addition, etiological connections between the Queen's early-onset and late-life depressions appeared probable. Underlined for contemporary practitioners are the suffering experienced by patients with vascular depression at the end of their lives, as well as the struggles of physicians like Sir James Reid to provide clinical wisdom and emotional support.