[Severe therapy refractory depression as initial manifestation of Parkinson disease]

A 60-year old female patient was referred to our University hospital with the diagnosis of severe treatment-resistant major depression to perform electroconvulsive therapy (ECT). For almost two years the patient had been treated with several antidepressants and, temporarily, neuroleptics. After showing no favourable response to ECT, the diagnosis of idiopathic Parkinson's disease was made and the patient was treated with L-dopa plus benserazide and pergolide in combination with the monoamine oxidase inhibitor moclobemide. Both depressed mood and motor symptoms showed dramatic improvement under this therapy.