We have proposed a subtype of vascular depression with two key elements: (1) presence of major depression and (2) presence of cerebrovascular disease on neuroimaging. Future studies are needed to refine these diagnostic criteria. There must be a consensus as to whether requiring major depression criteria is acceptable, or possibly too stringent. There are several methodological issues regarding cerebrovascular disease, including defining severity and thresholds, importance of location and system of assessment. Once agreement is reached on a working diagnosis of vascular depression, researchers will be in a position to estimate prevalence of the disorder, determine conditions that represent risk factors, and examine important outcomes in patients with vascular depression.