Abstract
Objective: To describe the course of depression in a patient with hepatolenticular degeneration (Wilson's disease).
Clinical picture: A 21 -year-old male with hepatolenticular degeneration is described in whom depression was the earliest manifestation. Insomnia and psychomotor slowing were prominent.
Treatment: The mood disturbance showed limited response to tricyclic antidepres-sants, mianserin, lithium augmentation and initial decoppering therapy. Introduction of the chelating agent tetrathiomolybdate was followed by normalisation of mood and improvement in non-psychiatric symptoms.
Outcome: Three years after the disorder was first diagnosed the patient was euthymic and fully functional.
Conclusions: Although hepatolenticular degeneration is rare, it commonly presents with psychiatric symptoms. It is important for psychiatrists to be aware of the condition and its psychiatric manifestations.
