Refractory Major Depression Successfully Treated With Electroconvulsive Therapy in a Patient With Addison Disease

Abstract

This report describes a 55-year-old woman who had 1 previous episode of major depression that responded favorably to treatment with tricyclic antidepressants. After the development of Addison disease, she experienced a new episode of major depression that failed to respond to adequate treatment with imipramine and was subsequently successfully treated with electroconvulsive therapy (ECT) with steroid cover. The patient did not experience adrenal crisis or adverse effects. After 9 ECT sessions, she attained full remission. These findings support the suggestion that ECT treatment is safe in patients with Addison disease when using 100 mg intravenous hydrocortisone as prophylaxis.

Anesthesia Management of Special Patient Populations Undergoing Electroconvulsive Therapy: A Review

“…Addison disease, or primary adrenocortical insufficiency, is a rare disorder with a mean incidence of approximately 6 new cases per million per year 57,58 . Major depression is a frequent occurrence in patients with Addison disease 57,58 .…”

“…Addison disease, or primary adrenocortical insufficiency, is a rare disorder with a mean incidence of approximately 6 new cases per million per year 57,58 . Major depression is a frequent occurrence in patients with Addison disease 57,58 . Although glucocorticoid replacement may alleviate major depression in these patients, some have persistent major depression despite adequate replacement therapy 58,59 .…”

“…Major depression is a frequent occurrence in patients with Addison disease 57,58 . Although glucocorticoid replacement may alleviate major depression in these patients, some have persistent major depression despite adequate replacement therapy 58,59 . Major depression is associated with both hyper-and hypocortisolemia, with hypocortisolemia being more prevalent in patients with chronic major depression 58 .…”

“…Although glucocorticoid replacement may alleviate major depression in these patients, some have persistent major depression despite adequate replacement therapy 58,59 . Major depression is associated with both hyper-and hypocortisolemia, with hypocortisolemia being more prevalent in patients with chronic major depression 58 . Whether the efficacy of antidepressants in patients with depression with Addison disease is similar to that in physically healthy patients with depression is unknown 58 .…”

“…Major depression is associated with both hyper-and hypocortisolemia, with hypocortisolemia being more prevalent in patients with chronic major depression 58 . Whether the efficacy of antidepressants in patients with depression with Addison disease is similar to that in physically healthy patients with depression is unknown 58 . Nevertheless, Heijnen et al 58…”