title: Depression in hepatolenticular degeneration (Wilson's disease).
abstract: OBJECTIVE
  To describe the course of depression in a patient with hepatolenticular degeneration (Wilson's disease).
  
  
  METHODS
  A 21-year-old male with hepatolenticular degeneration is described in whom depression was the earliest manifestation. Insomnia and psychomotor slowing were prominent.
  
  
  METHODS
  The mood disturbance showed limited response to tricyclic antidepressants, mianserin, lithium augmentation and initial decoppering therapy. Introduction of the chelating agent tetrathiomolybdate was followed by normalisation of mood and improvement in non-psychiatric symptoms.
  
  
  RESULTS
  Three years after the disorder was first diagnosed the patient was euthymic and fully functional.
  
  
  CONCLUSIONS
  Although hepatolenticular degeneration is rare, it commonly presents with psychiatric symptoms. It is important for psychiatrists to be aware of the condition and its psychiatric manifestations.
authors.affiliation: Rivendell Unit, Central Sydney Area Health Service, Hospital Road, Concord West, New South Wales, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Walter
authors.forename: B
authors.initials: B
authors.lastname: Lyndon
mesh_terms: D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D002614:Chelating Agents / Q000627:therapeutic use; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006527:Hepatolenticular Degeneration / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008297:Male; D008803:Mianserin / Q000627:therapeutic use; D008982:Molybdenum / Q000627:therapeutic use; D011596:Psychomotor Disorders / Q000175:diagnosis / Q000453:epidemiology; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D000929:Antidepressive Agents, Tricyclic; D002614:Chelating Agents; D008803:Mianserin; D008982:Molybdenum; C020809:tetrathiomolybdate