title: Prednisone augmentation in treatment-resistant depression with fatigue and hypocortisolaemia: a case series.
abstract: 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.
authors.affiliation: Department of Psychological Medicine, University of Otago University, Dunedin, New Zealand. colin.bouwer@stonebow.otago.ac.nz
authors.forename: C
authors.initials: C
authors.lastname: Bouwer
authors.forename: J
authors.initials: J
authors.lastname: Claassen
authors.forename: T G
authors.initials: TG
authors.lastname: Dinan
authors.forename: C B
authors.initials: CB
authors.lastname: Nemeroff
mesh_terms: D000309:Adrenal Insufficiency / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003346:Corticotropin-Releasing Hormone / Q000097:blood; D003865:Major Depressive Disorder / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005221:Fatigue / Q000097:blood / Q000209:etiology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use*; D013577:Syndrome; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D000928:Antidepressive Agents; D003346:Corticotropin-Releasing Hormone; D011241:Prednisone; D006854:Hydrocortisone