Question: I have been told that I either have Pseudo-Cushing's or a form of Cushing's that has not been detected by standard tests. It has been suggested that I take antidepressants for a while, specifically one of the serotonin reuptake inhibitors. Why should I do this?

Answer: First, antidepressant therapy usually works for both the depression of Cushing's and that of Pseudo-Cushing's states. Secondly, with Cushing's, the antidepressant does not influence cortisol hypersecretion. In cases of Pseudo-Cushing's, which are believed to result from a biochemical over stimulation of the stress axis, antidepressants can normalize hypersecretion. In that sense, a therapeutic trial with an antidepressant can be diagnostic of either condition. Both the serotonin reuptake inhibitors and the tricyclic antidepressants serve to increase serotonin and should work equally well in Cushing's and Pseudo-Cushing's states.