The dexamethasone suppression test in prepubertal depressed children

The dexamethasone suppression test (DST) was performed in 50 hospitalized prepubertal children who met DSM-III criteria for major depressive episode, 18 hospitalized controls with a psychiatric disorder, and 18 nonhospitalized normal controls. Baseline and post-DST cortisol levels were measured at 8 a.m. and 4 p.m. The depressed children had consistently higher cortisol levels than the controls at baseline and post-DST. The DST was positive in 82% of depressed children, 28% of psychiatric controls, and 11% of normal controls. The results indicate that prepubertal depressed children may have abnormalities in the hypothalamic-pituitary-adrenal axis similar to those in adults with a major depressive illness.     

The research diagnostic criteria for endogenous depression and the dexamethasone suppression test: a discriminant function analysis

Most studies examining the validity of the Research Diagnostic Criteria (RDC) for endogenous depression have been negative. RDC endogenous subtyping is not associated with short- or long-term treatment outcome, family history of affective disorder, or premorbid personality disorder. Studies examining its relationship to the dexamethasone suppression test (DST) are mixed; half report a significant association, and half do not. The RDC endogenous diagnosis may lack validity either because the criteria do not represent, or are not specific to, the endogenous subtype, or the diagnostic algorithm is inappropriate. In the present study, we conduct a discriminant function analysis on the 10 criteria for the endogenous subtype using DST results as the independent variable. We constructed a new diagnostic algorithm and cross-validated it on a second patient sample. In both samples the discriminant function classification was significantly associated with DST results, whereas the RDC algorithm was not.     

Comparison of the ACTH suppression test and dexamethasone suppression test in depressed patients

Fourteen depressed patients were given the dexamethasone and ACTH suppression tests. The results of 71% agreed, suggesting that in a subgroup of depressed patients dexamethasone resistance reflects a central rather than peripheral dysfunction of the hypothalamic-pituitary-adrenal axis.     

The dexamethasone suppression test in depressed and non-depressed geriatric medical inpatients

The frequency of an abnormal response to the dexamethasone suppression test (DST) was examined in 38 geriatric patients hospitalized for medical illnesses and affected by depressive disorders diagnosed according to the DSM III, and in 18 medical patients (used as controls) hospitalized in the same ward. Only 11% of the controls and 11% of those affected by dysthymic disorder had an abnormal DST vs 73% of the patients with major depressive disorder (MDD). The sensitivity of the DST for MDD, in this particular setting, was found to be about 73% and the specificity 89%. The importance of this clinical adjunct in diagnosing the severe depressive disorders is discussed.     

The dexamethasone suppression test in depressed outpatients and normal control subjects

In contrast to a recently published report by Amsterdam and associates, the authors noted a higher frequency of abnormal dexamethasone suppression test results in 88 outpatients with primary depression (particularly the endogenous subtype) than in 49 normal controls.     

The dexamethasone suppression test in depressed retarded adults: preliminary findings

This study was undertaken to determine the utility of the Dexamethasone Suppression Test (DST) for diagnosing depression in institutionalized mentally retarded persons. Depressed and nondepressed institutionalized mentally retarded persons were given 1 mg dexamethasone for an overnight DST. Serum cortisol concentrations greater than 4 micrograms/dl at both 8:00 AM and 4:00 PM provided discrimination of depressed from nondepressed groups. Also, using the criteria of serum cortisol concentrations greater than 4 micrograms/dl at 8:00 AM and 4:00 PM, at 4:00 PM and 10:00 PM, or at 8:00 AM, 4:00 PM, and 10:00 PM differentiated these groups. These results suggest that the DST may be useful for detecting melancholia among institutionalized retarded persons.     

The dexamethasone suppression test in depressed, dysthymic, and nondepressed children

Dexamethasone suppression tests were given to seven children with major depression, six dysthymic children, and 17 children without affective disorders. The test showed sensitivity for major depressive disorder (87%) but a low specificity (53%).     

Misuse of the dexamethasone suppression test as a diagnostic tool

The diagnostic reliability and appropriateness of use of the Dexamethasone Suppression Test (DST) were assessed by a retrospective chart survey of ninety-nine psychiatric admissions to a community hospital. A change in psychiatric diagnosis between admission and discharge occurred in one-third of the patients. The diagnostic change appeared to be associated with the DST result more than the clinical findings. Such reliance on the test was not justified as the observed diagnostic confidence of the DST in supporting a diagnosis of major depression was only 38 percent. These findings suggest a misuse of the test as a diagnostic tool in routine practice.     

The dexamethasone suppression test and thyroid stimulating hormone response to TRH in RDC schizoaffective patients

Summary The dexamethasone suppression test (DST) brought to light significantly more non-suppression of cortisol secretion in RDC schizoaffectives of the depressed (89%) and of the manic type (67%) than in RDC schizophrenia (25%). However, only in the RDC endogenous depressives, whose pathological DST rate was 57%, was the thyroid stimulating hormone (TSH) response to thyrotrophin releasing hormone (TRH) found to be significantly blunted. It is suggested that the DST results can be interpreted as partially validating DSM-III's wide major affective disorder since this concept also encompasses all cases with mood-incongruent psychotic features. Furthermore, it is hypothesized that the coupling of DST non-suppression and TSH blunting may be important for defining a valid depressive subgroup within these extended clinical boundaries for affective illness.     

Platelet MAO activity and the dexamethasone suppression test in depressed patients

Platelet monoamine oxidase (MAO) activity and postdexamethasone cortisol levels were determined in 26 depressed patients. The incidence of cortisol nonsuppression and the mean postdexamethasone cortisol levels were significantly higher in patients with high MAO activity than in those with low MAO activity.     

Platelet MAO activity, TRH test, and dexamethasone suppression test in depressed patients

Platelet MAO activity, TRH test and DST results were compared in 23 normal subjects and 13 depressed patients. Patients as a group were older in age, had higher levels of FT4-index and T3-uptake, and lower levels of MAO activity. There was no association between thyroid hormones, including TSH response, and MAO activity. Five patients were DST positive. They showed a higher average age and a higher T3-uptake value than DST negative patients. Serum T4 and MAO activity levels were normal in both groups. These data suggest that MAO activity and TSH are independently regulated in both normal subjects and depressed patients. They also suggest a reduced binding capacity for thyroid hormones in patients with positive DST.     

The dexamethasone suppression test in bulimia

Nineteen (35%) of 55 women with bulimia failed to exhibit cortisol suppression after dexamethasone administration. Although there was no statistically significant difference between suppressors and nonsuppressors on any clinical variable, there was a higher frequency of major depression among nonsuppressors.     

The dexamethasone suppression test in dementia

The dexamethasone suppression test (DST) was performed on 13 patients with multi-infarct dementia (MID), 5 patients with primary degenerative dementia (PDD) and 18 elderly controls. Abnormal lack of suppression was found in 7 demented patients (3 with PDD, 1 mild and 2 severe, and 4 with MID, 1 mild and 3 severe), and in 2 of the controls. Only one demented patient was depressed. The value of DST in the differential diagnosis of dementia from the major depressive disorders is discussed.

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Sommario Il test di soppressione al desametazone (DST) è stato applicato a 13 pazienti con demenza multi-infartuale (MID), a 5 pazienti affetti da demenza degenerativa primaria (PDD), e a 18 controlli (anziani). Una nonsoppressione è stata ritrovata in 7 pazienti affetti da demenza (3 di tipo PDD, in 1 caso di grado moderato ed in 2 casi severo, e 4 di tipo MID, in 1 caso moderato ed in 3 casi severo). Solo uno dei pazienti affetti da demenza si presentava contemporaneamente affetto da depressione. Viene discussa l’utilità del DST nel giudizio diagnostico-differenziale tra la demenza ed il disturbo depressivo maggiore.

     

The dexamethasone suppression test in depression

The DST does appear to be abnormal in a sizable subgroup of patients with major depressive disorder, particularly those characterized as "endogenomorphic" or "melancholic." At present the available data seem clear in indicating this abnormality is significantly less common in normal controls and patients without affective illness. The test holds considerable promise in helping to define new subgroups of depressed individuals for further study. In terms of its ability to predict treatment response to an adequate course of somatic therapy, the test does not appear to be of value, and the clinician should still be guided by the clinical presentation and history in initiating or choosing between various somatic treatments. With further attention to issues of diagnosis and DST methodology this strategy could help in addressing questions of differential diagnosis in potential "variants" of affective illness and providing a better understanding of the pathophysiology of depression.