COURSE OF DEPRESSION IN CUSHINGS-SYNDROME - RESPONSE TO TREATMENT ANDCOMPARISON WITH GRAVES-DISEASE

Depression is a common, life-threatening complication of Cushing's syn drome and may occur in several other endocrine disorders. It is not cl ear, however, whether distinct features pertain to hypercortisolism. W e studied depression in Cushing's syndrome differentiating pituitary-d ependent and pituitary-independent forms, its incidence compared to Gr aves' disease, and its appearance in the prodromal phase of both condi tions. To 66 consecutive patients with Cushing's syndrome and 70 with Graves' disease, after treatment, a semistructured interview for depre ssive symptoms based on Paykel's clinical interview for depression was administered. In Cushing's syndrome, the response of depression to no rmalization of urinary cortisol levels was evaluated by Kellner's glob al rating method. There was a significant difference in the occurrence of depression (p < 0.001) between Cushing's syndrome (62%) and Graves ' disease (23%). Depression appeared in the prodromal phase in 27% of patients with Cushing's syndrome and in 14% of those with Graves' dise ase, but the difference was not significant. In Cushing's syndrome, th ere were no significant differences in depression between patients wit h pituitary-dependent (n = 41) and pituitary-independent (n = 20) form s, or in their response to treatment. About 70% of patients fully reco vered from their depression, whereas there was no substantial change i n the others and even worsening in 2. Our findings in Cushing's syndro me and Graves' disease are in agreement with previous investigations u sing specific diagnostic criteria for depression. We found a tendency for this symptom to manifest in the prodromal phase of both illnesses. An endocrine etiology should be, therefore, considered in depressed p atients not responding to standard psychiatric treatment.