Abnormalities of the hypothalamic‐pituitary‐adrenal (HPA) axis have long been implicated in major depression with hypercortisolaemia reported in typical depression and hypocortisolaemia in some studies of atypical depression. We report on the use of prednisone in treatment‐resistant depressed patients with reduced plasma cortisol concentrations. Six patients with treatment‐resistant major depression were found to complain of severe fatigue, consistent with major depression, atypical subtype, and to demonstrate low plasma cortisol levels. Prednisone 7.5 mg daily was added to the antidepressant regime. Five of six patients demonstrated significant improvement in depression on prednisone augmentation of antidepressant therapy. Although hypercortisolaemia has been implicated in some patients with depression, our findings suggest that hypocortisolaemia may also play a role in some subtypes of this disorder. In treatment‐resistant depressed patients with fatigue and hypocortisolaemia, prednisone augmentation may be useful. Depression and Anxiety 12:44–50, 2000. © 2000 Wiley‐Liss, Inc.

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Twenty-one students attended the inaugural Institute. Twenty-seven speakers contributed to the morning seminars and there were 17 clinical elective site visits. Feedback from students was positive and the week was rated highly, both in terms of its organization and from an academic perspective. It is planned to run the Institute annually and, in time, it is hoped that it will increase the numbers of students who choose psychiatry as a career option.

Undergraduate psychiatric teaching is an essential part of general family physicians' training and practice. Undergraduate students' exposure to psychiatry might be inadequate. Curricular goals, teaching and evaluation of students need to be aligned. Research and information technology can play a bigger role in teaching. Validation of patients, students and teachers during the teaching process is important, but not always emphasized. Educators should be aware of society's unwritten expectations, judgements and opinions of mental illness sufferers. Identifying and facilitating the various interacting domains during psychiatric teaching may contribute to better education in psychiatry, better retention of knowledge for students and an improved recruitment of students to a psychiatric career.