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December 1985, Vol 42, No. 12 >
Article | December 1985

The Dexamethasone Suppression Test for Diagnosis and Prognosis in Psychiatry: Title and subTitle BreakCommentary and Review

George W. Arana, MD; Ross J. Baldessarini, MD; Marjorie Ornsteen
[+] Author Affiliations

Accepted for publication Aug 8, 1985.

Reprint requests to the Department of Psychiatry, Boston Veterans Administration Medical Center, 150 S Huntington St, Boston, MA 02130 (Dr Arana).


Arch Gen Psychiatry. 1985;42(12):1193-1204. doi:10.1001/archpsyc.1985.01790350067012
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Comments

• A modified dexamethasone suppression test (DST) has had unprecedented evaluation among biologic tests proposed for clinical use in psychiatry. It has not proved to reflect pathophysiologic changes at the level of the central nervous system or pituitary, and tissue availability of dexamethasone itself may contribute to test outcome. The sensitivity of the DST in major depression is limited (about 44% in over 5,000 cases) but is higher in psychotic affective disorders and mixed manic-depressive states (67% to 78%). The high specificity of the DST vs control subjects (over 90%) is not maintained vs other psychiatric disorders (77% specificity overall), and acute "distress" may contribute to nonsuppression of cortisol. The test may have power in differentiating severe melancholic depression, mania, or acute psychosis from chronic psychosis (87% specificity) or dysthymia (77% specificity). The DST status adds about 11% to the prediction of short-term antidepressant response. Suggestions that failure to maintain normal suppression of cortisol predicts poor outcome are not secure. Uncritical enthusiasm or excessive skepticism regarding the DST are unwarranted.

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207 +
Godwin CD, Greenberg LB, Shukla S:  Consistent dexamethasone suppression test results with mania and depression in bipolar illness . Am J Psychiatry 1984;;141:1263-1265.
208 +
Redding M, Orto L, Willensky P, Fortuna I, Day N, Steiner SF, Gehr L, McDowell F:  The dexamethasone suppression test: An indicator of depression in stroke but not a predictor of rehabilitation outcome . Arch Neurol 1985;;42:209-212.
209 +
Baldessarini RJ, Finklestein S, Arana GW:  The predictive power of diagnostic tests and the effect of prevalence of illness . Arch Gen Psychiatry 1983;;40:569-573.
210 +
Sangal R, Correa EI, DePaulo JR:  Depression and anxiety inventories and the dexamethasone suppression test . Biol Psychiatry 1984;;19:1207-1213.
211 +
Arana GW, Barreira PJ, Lipinski J, Schacter H, Cohen BM, Ornsteen M: Is DST outcome related to severity of symptoms?, abstract NR96. Proceedings of the Annual Meeting of the American Psychiatric Association, Dallas, May 18-24, 1985, p 60.
212 +
Gold MA, Pottash ALC, Extein I:  Dexamethasone suppression test in depression and response to treatment . Lancet 1980;;1:1190.
213 +
Coryell W:  Hypothalamic-pituitary-adrenal axis abnormality and ECT response . Psychiatry Res 1982;;6:283-291.
214 +
Peselow ED, Fieve RR:  Dexamethasone suppression test and response to antidepressants in depressed outpatients . N Engl J Med 1982;; 307:1216-1217.
215 +
Schlesser MA, Rush JA: DST states in relation to desipramine response. Society for Biological Psychiatry Scientific Proceedings, Toronto, May 12-16, 1982.
216 +
Qualls CB, Brown WA: Dexamethasone suppression test subgroups differ in ECT response, abstract NR36. Proceedings of the Annual Meeting of the American Psychiatric Association, Toronto, May 18-21, 1982.
217 +
Ettigi PG, Hayes PE, Narasimhachari N, Hamer RM, Goldberg S, Secord GJ:  D-Amphetamine response and dexamethasone suppression test as predictors of treatment outcome in unipolar depression . Biol Psychiatry 1983;;18:499-504.
218 +
Spar JE, LaRue A:  Major depression in the elderly: DSM-III criteria and the dexamethasone suppression test as predictors of treatment response . Am J Psychiatry 1983;;140:844-847.
219 +
Yerevanian BI, Olofsdottir H, Milanese E, Rusotto J, Mallon P, Balciewicz G, Sagi G:  Normalization of the dexamethasone suppression test at discharge from hospital . J Affective Disord 1983;;5:191-197.
220 +
Shrivastava RV, Schwimmer R, Browne WA, Arito M: DST predicts poor placebo response in depression, abstract NR94. Proceedings of the Annual Meeting of the American Psychiatric Association, Dallas, May 18-24, 1985.
221 +
Spiker DG, Weiss JC, Dealy RS, Griffin SJ, Hanin I, Neil JF, Perel JM, Rossi AJ, Soloff PH:  The pharmacological treatment of delusional depression . Am J Psychiatry 1985;;142:430-436.
222 +
Minter RE, Mandel MR:  The treatment of psychotic major depressive disorder with drugs and electroconvulsive therapy . J Nerv Ment Dis 1979;;162:726-733.
223 +
Goodwin FK:  The impact of tricyclic antidepressants and lithium on the course of recurrent affective disorders . McLean Hosp J 1983;;8:1-16.
224 +
Albala AA, Greden J:  Serial dexamethasone suppression tests in affective disorders . Am J Psychiatry 1980;;137:383.
225 +
Greden JF, Albala AA, Haskett RF, James NM, Goodwin L, Steiner M, Carroll BJ:  Normalization of dexamethasone suppression test: A laboratory index of recovery from endogenous depression . Biol Psychiatry 1980;; 15:449-458.
226 +
Holsboer F, Steiger A, Maier W:  Four cases of reversion to abnormal dexamethasone suppression test response as indicator of clinical relapse: A preliminary report . Biol Psychiatry 1983;;18:911-916.
227 +
Nemeroff CB, Evans DL:  Correlation between the dexamethasone suppression test in depressed patients and clinical response . Am J Psychiatry 1984;;141:247-249.
228 +
Targum SD:  Persistent neuroendocrine dysregulation in major depressive disorder: A marker for early relapse . Biol Psychiatry 1984;;19:305-318.
229 +
Hudson JI, Hudson MS, Rothschild AJ, Vignati L, Schatzberg AF, Melby JC:  Abnormal results of the dexamethasone suppression tests in nondepressed patients with diabetes mellitus . Arch Gen Psychiatry 1984;; 41:1086-1089.
230 +
Cameron OG, Kronfol Z, Greden JF, Carroll BJ:  Hypothalamic-pituitary-adrenocortical activity in patients with diabetes mellitus . Arch Gen Psychiatry 1984;;41:1090-1095.
231 +
Smith SR, Bledsoe T, Chhetri MK:  Cortisol metabolism and the pituitary-adrenal axis in adults with protein caloric malnutrition . J Clin Endocrinol Metabol 1975;;40:43-52.
232 +
Doerr P, Fichter M, Pirke KM, Lund R:  Relationship between weight gain and hypothalamic pituitary adrenal function in patients with anorexia nervosa . J Steroid Biochem 1980;;13:529-537.
233 +
Edelstein CK, Roy-Byrne P, Fawazy FI, Dornfield L:  Effects of weight loss on the dexamethasone suppression test . Am J Psychiatry 1983;; 140:338-341.
234 +
Dilsaver SC, Greden JF:  Effects of antidepressant withdrawal on the dexamethasone suppression test . Psychiatry Res 1985;;14:111-122.
235 +
Wilens TE, Ritchie JC, Carroll BJ:  Comparison of plasma cortisol and corticosterone in the dexamethasone suppression test for melancholia . Psychoneuroendocrinology 1984;;9:45-56.
236 +
Arana GW, Wilens TE, Baldessarini RJ:  Plasma corticosterone and cortisol following dexamethasone in psychiatric patients . Psychoneuroendocrinology 1985;;10:49-60.
237 +
Robbins DR, Alessi NE:  Suicide and the dexamethasone suppression test in adolescence . Biol Psychiatry 1985;;20:107-110.

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