Munchausen syndrome, depression, and the dexamethasone suppression test

The authors describe two patients with Munchausen syndrome who met DSM-III criteria for major depression. Both patients exhibited evidence of nonsuppression of serum cortisol by dexamethasone. Although many patients with Munchausen syndrome have been reported to be depressed, only a few have received a diagnosis of major depression. Because the physical and psychiatric symptoms of the Munchausen patient are so complex, clinical assessment may stop at a diagnosis of Munchausen syndrome, and major depression may be overlooked. A diagnosis of major depression should be considered in the evaluation of these patients; the dexamethasone suppression test may enhance clinical assessment.