THE PSYCHOTROPIC EFFECTS OF INHIBITORS OF STEROID-BIOSYNTHESIS IN DEPRESSED-PATIENTS REFRACTORY TO TREATMENT

Twenty patients, diagnosed as suffering from treatment-resistant major depression were treated with one or more drugs that decrease corticos teroid biosynthesis. Nine were psychotic, 11 nonpsychotic. Seventeen c ompleted the treatment (8 psychotic, 9 nonpsychotic); 13 responded (5 psychotic, 8 nonpsychotic; 11 responded completely (i.e., a drop in th e Hamilton Depression Scale of at least 50%, to less than or equal to 15), and 2 responded partially, The mean age of the responders (45.2 /- 12.6 years) did not differ significantly from that of the nonrespon ders (48.7 +/- 12/3), Data were analyzed in the following categories; (1) the presence or absence of psychosis, (2) response or nonresponse to treatment, and (3) the drug(s) used (aminoglutethimide, ketoconazol e, or a combination of either of these with metyrapone), The patients improved over time on the Hamilton Depression Scale independent of the medication used. Responders demonstrated improvement in mood, insomni a, anxiety, diurnal variation, paranoia and obsessive compulsiveness, Nonpsychotics responded better than psychotics.