Idiopathic intracranial hypertension.

Abstract

To the Editor: Kleinschmidt et al.1 reported that relative to controls, patients with idiopathic intracranial hypertension (IIH) had a higher prevalence of adverse health problems and health-related psychosocial concerns, as well as higher levels of depression and anxiety measured by questionnaire. The authors suggest that while obesity may be related to depression and lower quality of life in patients with IIH, other factors may be involved. Eighteen years ago, my colleagues and I described seven patients,2 including two sisters,3 who developed IIH 2 weeks following the resolution of a major depressive episode. We noted that both IIH and major depression are associated with disturbances in the hypothalamic-pituitary-adrenal axis, and speculated that declining corticosteroid levels in a resolving depression may result in impaired cerebrospinal fluid absorption and development of IIH. Thus, a link may exist between neuroendocrine disturbances, depressive symptoms, and quality of life in patients with IIH. I agree with Kleinschmidt et al. that a relation exists between IIH and depressive illness, and suggest that at least in some patients, it is a result of neuroendocrine alterations common to both conditions. Additional research is needed to examine the contributions of psychosocial and neurobiologic (including neuroendocrine) factors to depressive symptoms and quality of life in patients with IIH.