L. De Jonge

Between Scylla and Charybdis: Where does the treatment of Addison's disease in late-life depression go first?

Introduction Older adults with adrenocortical insufficiency, including Addisons disease (AD), are at an increased risk for developing late-life depression. Treatment of AD with glucocorticoid replacement therapy may exacerbate depressive symptoms and may complicate treatment of late-life depression. Objectives To present a case with algorithm of decision-making in a particular case of glucocorticoid induced depression in patient with syndrome of Addison. Aims To report a case-study, describing treatment of Addisons disease in LLD. Methods A case report is presented and discussed, followed by a literature review. Results A 77-year-old female, diagnosed with Addisons disease, was referred with persistent fatigue, weakness, weight loss, sleep disturbances, and depressive symptoms over the previous 6xa0months. She was taken losartan 100xa0mg/day, zolpidem 10xa0mg/day, fludrocortisone 100xa0μg/day, and hydrocortisone 35xa0mg/day. There was no personal or family history of psychiatric problems. Clinical examination was normal aside from skin hyperpigmentation. After initial minimal dose reduction of glucocorticoids, Addisons disease remained under control. One week later, her depressive symptoms disappeared without administration of antidepressants. Conclusion The association between glucocorticoid replacement therapy and late-life depression is not well understood. The current case shows that treatment of glucocorticoid-induced depression in subjects with Addisons disease is achievable by minimal adjustments in glucocorticoid regiment. However, collaboration with endocrinology is of vital importance to prevent an Addisons crisis. Pharmacokinetic dose-finding studies are required to find optimal glucocorticoid adjustment strategy.

Electroconvulsive therapy in depressed older adults with unrepaired abdominal aortic aneurysm: Safety first!

Introduction It is not clear whether electroconvulsive therapy (ECT) is a safe procedure in depressed older adults with unrepaired abdominal aortic aneurysm (AAA). ECT is potentially incriminating to the cardiovascular system due to a transiently elevation of blood pressure and heart rate during the seizure. Objectives To report a case of an older adult presenting a psychotic depression complicated by an unrepaired AAA. Aims To report a case study, describing the safety of ECT in patients with unrepaired AAA. Methods A case report and retrospective review was conducted. Results A 75-year-old male was admitted to hospital for the treatment of a psychotic depression. Treatment was complicated since for one year he was diagnosed with an AAA (diameter 4.7xa0cm). In collaboration with vascular surgeons and anesthesiologists we decided to start ECT. After fourteen ECTs an improvement of mood was achieved. Post-ECT we noticed an AAA expansion of 0.1xa0cm. Conclusions Our findings indicate that ECT may be a safe procedure for patients diagnosed with unrepaired AAA. Published data suggest that the risk for aortic aneurysm rupture during ECT is low. However, multidisciplinary collaboration among psychiatrists, anesthesiologists and vascular surgeons is essential for a positive outcome.