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

Heijnen, Willemijn T.C.J. MD; Pluijms, Esther M. MD; Birkenhager, Tom K. MD, PhD

doi: 10.1097/YCT.0b013e3182756695
Case Reports

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.

From the Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands.

Received for publication July 2, 2012; accepted September 20, 2012.

Reprints: Tom K. Birkenhager, MD, PhD, Department of Psychiatry, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands (e-mail:

The authors declare no conflict of ineterest.

T.K.B. has received a grant from Lundbeck BV and speaker’s fees from Lundbeck BV, Servier, and AstraZeneca.

© 2013 by Lippincott Williams & Wilkins