Globus hystericus--a somatic symptom of depression? The role of electroconvulsive therapy and antidepressants.

Abstract

An association of "globus hystericus" with depressive illness has already been established. Successful treatment with antidepressants has been previously reported but this is the first report of globus symptom responding to electroconvulsive therapy (ECT) followed by long-term remission on maintenance dose with tricyclic antidepressant. A detailed retrospective study of an elderly patient's General Practice medical notes revealed 45-year history of recurrent globus symptom, interspersed with other somatic complaints. Patient's frequency of consultations with her family physician was noted before treatment and during the 5-year follow-up period. Using DSM-III diagnostic categories, the patient was diagnosed as suffering from major depressive disorder with globus symptom. The notes were insufficient to ascertain whether past episodes of globus occurred in a setting of depressive disorder. A prompt response of globus symptom to ECT was observed with 5-year symptom-free follow-up period as long as the patient remained on a maintenance dose of antidepressant. A marked reduction in frequency of medical consultations for other somatic complaints was noted. The case illustrates a strong association of globus symptom with depressive disorder and other somatic concerns. Patients with recurrent globus symptom and family history of depressive illness should be screened for a possibility of depressive disorder. ECT and antidepressants may be successfully used in treatment of globus in a setting of depressive illness. Long-term maintenance with antidepressive medication may keep at least some of these patients symptom-free. It is suggested that globus hystericus could be more appropriately viewed as a somatic symptom of depression rather than a conversion disorder.