The authors report the case of a male 61-year-old patient with Cotard's syndrome. Onset occurred three years ago with depressive symptoms that did not show the specific features of the syndrome, but failed to respond fully to treatment with tricyclic antidepressants. A probable later recurrence was characterised by elements typical of Cotard's syndrome. Treatment with tricyclic and serotoninergic antidepressants was ineffective. Encephalic NMR showed multiple ischemic foci and signs of cortical atrophy. Three years after the onset of depressive symptoms Cotard's syndrome is virtually unchanged and shows ingravescent mental deterioration.