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PubMed1991

Serial dexamethasone suppression tests and plasma dexamethasone levels. Effects of clinical response to electroconvulsive therapy in major depression.

Serial 1-mg dexamethasone suppression tests with concurrent plasma dexamethasone assessments were conducted in 58 patients with endogenous depression treated with electroconvulsive therapy (ECT). Plasma cortisol levels decreased significantly from pretreatment to immediately posttreatment, and they declined further during the first week after the ECT course, when patients remained drug free. Plasma dexamethasone levels showed an opposite pattern of progressive increases over these three time points. The progressive changes in plasma dexamethasone and cortisol levels seen during the week after ECT indicate that alterations in the bioavailability of dexamethasone and in hypothalamic-pituitary-adrenal axis function may be incomplete immediately after the ECT course. This may partly account for previous inconsistencies in serial dexamethasone suppression test findings with this treatment modality. The major finding was that clinical response was associated with increased plasma dexamethasone levels, whereas changes in cortisol levels were independent of clinical outcome. With ECT, changes in plasma dexamethasone levels may be more related to changes in clinical state than changes in postdexamethasone cortisol levels. The extent to which clinical recovery with other treatments in depression is associated with altered bioavailability of dexamethasone and perhaps other compounds is unknown and in need of investigation.

Age Factors↗
PubMed1986

The TRH stimulation test and the dexamethasone suppression test in depression.

The thyrotropin-releasing hormone (TRH) stimulation test and the dexamethasone suppression test (DST) were performed in 40 depressive patients. More endogenously depressed patients than nonendogenously depressed patients showed a blunted response to TRH. No difference was found in delta max thyroid-stimulating hormone (TSH) between patients who responded to dexamethasone administration with a normal suppression of cortisol and those who responded with nonsuppression.

Adult↗
PubMed1988

The dexamethasone suppression test and plasma dexamethasone in generalized anxiety disorder.

A Dexamethasone Suppression Test nonsuppression rate of 27% was found in a group of 30 generalized anxiety disorder patients before treatment. The dexamethasone concentrations in the eight nonsuppressors were significantly lower than in eight suppressors matched by sex and age, but were similar to those in five nonsuppressors from a matched normal control group. The dexamethasone concentrations in the generalized anxiety disorder suppressors and a matched group of eight normal control suppressors were similar. After successful nondrug behavioral treatment, all generalized anxiety disorder patients were suppressors. Posttreatment dexamethasone concentrations in the initial nonsuppressor patients remained significantly lower than in the initial suppressors. The results suggest that low plasma dexamethasone concentrations after 1 mg oral dexamethasone may confer a vulnerability to nonsuppression that may be expressed in the presence of high state anxiety.

Adult↗
PubMed1987

The methodological and statistical evaluation of medical tests: the dexamethasone suppression test in psychiatry.

Presented herein is a step-by-step discussion of the statistical evaluation of a medical test, using the literature concerning the DST to provide good and bad examples of its implementations. Specific topics of concern include: (1) conceptualization issues such as the definition of a test and its purpose; (2) implementation issues such as sampling and blindness; (3) analytic issues such as choice of statistical measures of quality; (4) issues of correct and realistic interpretation of results; and, finally (5) cost-benefit issues.

Clinical Laboratory Techniques↗
PubMed1988

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.

Adult↗
PubMed1987

Dexamethasone suppression test and plasma dexamethasone levels in bulimia.

A 1-mg dexamethasone suppression test (DST) was carried out in 66 women with bulimia and in 26 age- and sex-matched controls. Blood samples were obtained at 4 PM on the day following dexamethasone ingestion, and levels of cortisol and of dexamethasone in the plasma were measured. Thirty-two percent of the patients vs only 7% of the controls had plasma cortisol levels of 140 nmol/L (5 micrograms/dL) or greater following the DST (a positive DST). The plasma levels of dexamethasone varied substantially, and there was a significant inverse relationship between the plasma level of cortisol and that of dexamethasone. Patients with positive DST results had lower levels of plasma dexamethasone than did those with negative DST results, and the mean plasma level of dexamethasone was lower in the bulimic group than in the control group. These results suggest that factors other than a disturbance of hypothalamic-pituitary-adrenal activity may contribute to positive DST results in bulimia.

Adult↗
PubMed1987

Rapid normalization of the dexamethasone suppression test with mianserin.

Dexamethasone suppression tests (DSTs) were carried out in 6 depressed patients and 2 with schizophrenia before and 48 to 72 hours after starting treatment. All 8 were non-suppressors before treatment but the 5 patients treated with mianserin and 1 treated with chlorpromazine had normal suppression with the repeat DST, unrelated to clinical change. Non-suppression persisted in the 2 patients treated with ECT or haloperidol. Mianserin and chlorpromazine could, therefore, be associated with false negative DST results. Possible mechanisms for this are discussed.

Chlorpromazine↗
PubMed1986

The effect of serum dexamethasone concentrations in the dexamethasone suppression test.

Serum dexamethasone and cortisol concentrations were measured in a sample of 98 psychiatric inpatients during the course of the 1-mg oral overnight Dexamethasone Suppression Test (DST). Suppressors were found to have significantly higher serum dexamethasone concentrations than nonsuppressors at each time of sampling (8:00 AM, 4:00 PM, and 11:00 PM). There was a significant inverse curvilinear relationship between serum dexamethasone and cortisol concentrations at each sample time. Although serum dexamethasone concentration was a potent determinant of postdexamethasone serum cortisol concentration, there were still significantly higher serum concentrations of cortisol in patients with major depression compared with patients with other disorders when dexamethasone concentrations were statistically controlled. By taking serum dexamethasone concentrations into account in defining DST suppression status, a modest increase in diagnostic specificity was achieved, but no substantial change in sensitivity.

Adult↗
PubMed1984

Dexamethasone suppression test (DST) and plasma dexamethasone levels in depressed patients.

The dexamethasone suppression test (DST) was evaluated in newly hospitalized patients with a DSM-III diagnosis of major depression. Patients with other psychiatric disorders and a normal control group were also studied. Plasma dexamethasone levels were obtained in all patients, and the relationship between plasma cortisol and plasma dexamethasone was examined. Rates of non-suppression in patients with major depression (39%) were not significantly different from those in patients with minor depression (25%), mania (38%), or other psychiatric illnesses (17%). The ranges of dexamethasone levels at 8 a.m. and 4 p.m. were similar between patient groups and controls. However, there was a significant difference in dexamethasone levels between suppressors and nonsuppressors, irrespective of diagnosis, which could not be explained by differences in weight or plasma dexamethasone half-life. Inappropriately high dexamethasone levels were found in some patients with a 1 mg test, a problem that critically affects the sensitivity of the test procedure.

Adolescent↗
PubMed1998

The combined dexamethasone/corticotropin-releasing hormone stimulation test is more closely associated with features of diurnal activity of the hypothalamo-pituitary-adrenocortical system than the dexamethasone suppression test.

BACKGROUND: The dexamethasone suppression test (DST) is a widely used endocrine test in psychiatry, but was reported to not allow reliable inferences with regard to the basal activity of the hypothalamo-pituitary-adrenocortical (HPA) system. We compared the association of the standard DST and the combined dexamethasone/corticotropin-releasing hormone (DEX/CRH) challenge with parameters of diurnal cortisol profiles. METHODS: We performed a DEX/CRH challenge and 24-hour cortisol profiles in 25 depressed patients (mean age: 47.4 +/- 16.0 years) and 33 age-matched healthy controls (mean age: 51.4 +/- 19.3 years). RESULTS: A path analysis showed cortisol area under the curve (AUC) after CRH (= DEX/CRH status) to be dependent upon minimal 24-hour cortisol and evening frequency of pulsatile cortisol release. In contrast, postdexamethasone cortisol (= DST status) was related to 24-hour mean cortisol. Simple linear regressions supported an association of cortisol AUC with several parameters of the diurnal cortisol profiles, which was not true for the standard DST. CONCLUSIONS: We conclude that the combined DEX/CRH challenge test is more closely associated with the activity of the HPA system than the standard DST in healthy and depressed subjects.

Adrenocorticotropic Hormone↗
PubMed1986

Informed use of the dexamethasone suppression test.

Like all laboratory tests, the dexamethasone suppression test (DST) should be used as an aid to diagnosis in specified clinical contexts. The test is not appropriate for routine screening for all psychiatric patients; it is most useful in those with a clinical picture of endogenous or melancholic depression for whom treatment with antidepressant drugs or ECT is being considered. In such cases, normalization of the DST may precede and be prognostic of clinical improvement. By contrast, failure of the DST to normalize in hospitalized patients being considered for discharge may be an indicator of possible relapse. Factors that can invalidate the DST, producing spurious false-positive results, are described, and the general principles for sound clinical use of the DST as a laboratory test in psychiatry are summarized.

Bipolar Disorder↗
PubMed1996

Unreliability of TRH test but not dexamethasone suppression test as a marker of depression in chronic vasculopathic patients.

Thirteen vasculopathic nondepressed men, admitted to the hospital 2 weeks earlier because of stroke, 10 age- and weight-matched patients with major depression, and 10 age- and weight-matched normal controls were tested with TRH and on different occasion with the dexamethasone (DEX) suppression test (DST). Patients with stroke were tested again with TRH and DST after 1 year. All subjects were euthyroid. A blunted TSH response to TRH was observed in 77% of vasculopathic patients, 64% of depressed patients, and 27% of controls. Some depressed patients showed serum GH or cortisol increments in response to TRH. Nonsuppression to DEX was observed in 45% of depressed patients and 15% of vasculopathics but not in normal controls. These data indicate that, in contrast to cortisol nonsuppression to DEX, blunted TSH response to TRH has poor diagnostic value as a marker for depression after stroke and may merely represent the expression of neuroendocrine dysfunction associated with cerebral vasculopathy.

Aged↗
PubMedDate not supplied

The dexamethasone suppression test in depression.

The Dexamethasone Suppression Test (DST) was performed in 91 patients (depressive, manic and schizophrenic) and 11 healthy control persons. It was found that more endogenously depressed patients than non-endogenously depressed patients showed abnormal test results. The results were markedly influenced by the time of blood sampling, the diagnostic criteria and the plasma cortisol concentration threshold.

Adult↗
PubMed1987

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.

Aged↗
PubMed1987

The dexamethasone suppression test in psychiatry.

The dexamethasone suppression test (DST) for depression (melancholia) has been the focus of considerable recent interest because of claims that it may be a sensitive and specific biological marker for melancholia. When the data from four separate studies were combined, 52% of our patients with major depression were DST nonsuppressors. However, nonsuppression was also observed in 11% of manic patients, 20% of schizophrenic patients and 15% of nondepressed abstinent alcoholics. These results, in conjunction with other reports, suggest that the specificity of the test is not sufficiently high to make it a satisfactory general diagnostic test.

Alcoholism↗