Prednisone augmentation in treatment-resistant depression with fatigue andhypocortisolaemia: A case series

Abnormalities of the hypothalamic-pituitary-adrenal (HPA) axis have long be en implicated in major depression with hypercortisolaemia reported in typic al depression and hypocortisolaemia in some studies of atypical depression. We report on the use of prednisone in treatment-resistant depressed patien ts with reduced plasma cortisol concentrations. Six patients with treatment -resistant major depression were found to complain of severe fatigue, consi stent with major depression, atypical subtype, and to demonstrate low, plas ma cortisol levels. Prednisone 7.5 mg daily was added to the antidepressant regime. Five of six patients demonstrated significant improvement in depre ssion on prednisone augmentation of antidepressant therapy. Although hyperc ortisolaemia has been implicated in some patients with depression, our find ings suggest that hypocortisolaemia may also play a rob in some subtypes of this disorder . In treatment-resistant depressed patients with fatigue and hypocortisolaemia, prednisone augmentation may be useful. (C) 2000 Wiley-L iss, Inc.