Hostname: page-component-7c8c6479df-hgkh8 Total loading time: 0 Render date: 2024-03-27T19:42:19.464Z Has data issue: false hasContentIssue false

The Dexamethasone Suppression Test in Affective Disorder

Relationship to Clinical and Genetic Subgroups

Published online by Cambridge University Press:  29 January 2018

J. Mendlewicz
Affiliation:
Department of Psychiatry, Brussels University Clinics, Erasme Hospital, Free University of Brussels, 808 Route de Lennick, Brussels 1070, Belgium
G. Charles
Affiliation:
C.G.T.R., Department of Neurosciences, 6110 Montignies le Tilleul
J. M. Franckson
Affiliation:
Department of Medical Chemistry, Free University of Brussels

Summary

Plasma Cortisol suppression after dexamethasone administration in 113 consecutively hospitalized patients (54 patients with primary depression, 41 with secondary depression and 18 non-depressed controls) showed early morning hypersecretion of Cortisol and Cortisol non-suppression after dexamethasone mainly in patients with primary depression. The sensitivity of the dexamethasone suppression test was 79 per cent in unipolar and bipolar primary depressed patients, specificity 79 per cent and diagnostic confidence of a positive test 82 per cent. Non-suppression to dexamethasone was observed in 81 per cent of patients with psychotic depression but only 37 per cent of those with non-psychotic depression. Age, sex and severity of depression, menopausal status, or benzodiazepines did not influence results. There was no association between Cortisol non-suppresssion and any genetic subgroup of affective disorder.

Type
Research Article
Copyright
Copyright © Royal College of Psychiatrists, 1982 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Albala, A. A., Greden, J. F., Tarika, J. & Carroll, B. J. (1981) Changes in serial dexamethasone suppression tests among unipolar depressives receiving electroconvulsive treatment. Biological Psychiatry, 16, 551–60.Google ScholarPubMed
Amsterdam, M. D., Winokur, A. & Caroff, S. (1981) Effect of tricyclic antidepressants on the dexamethasone suppression test. American Journal of Psychiatry, 138, 1245–6.Google ScholarPubMed
Brown, W. A., Jonhson, R. & Mayfield, D. (1979) The 24-hour dexamethasone suppression test in a clinical setting: relationship to diagnosis, symptoms and response to treatment. American Journal of Psychiatry, 136, 543–7.CrossRefGoogle Scholar
Carroll, B. J., Martin, F. I. R. & Davies, B. M. (1968) Resistance to suppression by dexamethasone of plasma 11—OHCS levels in severe depressive illness. British Medical Journal, 2, 285–7.Google Scholar
Carroll, B. J. (1972) The hypothalamic—pituitary—adrenal axis in depression. In Depressive Illness: Some Research Studies, (eds. Davies, B., Carroll, B. J. and Mowbray, R. M.). Springfield: Thomas.Google Scholar
Carroll, B. J., Curtis, G. C. & Mendels, J. (1976) Neuroendocrine regulation in depression: II. Discrimination of depressed from non-depressed patients. Archives of General Psychiatry, 33, 1051–8.CrossRefGoogle Scholar
Carroll, B. J., Greden, J. F., Feinberg, M., James, M., Haskett, R. F., Steiner, M. & Tarika, J. (1980) Neuroendocrine dysfunction in genetic subtypes of primary unipolar depression. Psychiatric Research, 2, 251–8.CrossRefGoogle ScholarPubMed
Carroll, B. J., Feinberg, M., Greden, J. F., Tarika, J., Albala, A. A., Haskett, R. F., James, N. Mci., Kronfol, Z., Lohr, N., Steinert, M., De Vigne, J. P. & Young, E. (1981) A specific laboratory test for the diagnosis of melancholia: standardisation, validation and clinical utility. Archives of General Psychiatry, 38, 1522.CrossRefGoogle ScholarPubMed
Charles, G., Vandewalle, J., Meunier, J. C., Wilmotte, J., Noel, G., Fossoul, C., Mardens, Y. & Mendlewicz, J. (1981) Plasma and urinary Cortisol levels after dexamethasone in affective disorders. Journal of Affective Disorders, 3, 397406.CrossRefGoogle ScholarPubMed
Charles, G., Wilmotte, J., Quenon, M. & Mendlewicz, J. (1982) Reproductibility of the dexamethasone suppression test in depression. Biological Psychiatry. In press.Google Scholar
Coryell, W., Gaffney, G. & Burkhardt, P. E. (1982) The dexamethasone suppression test and familial subtypes of depression—a naturalistic replication. Biological Psychiatry, 17, 3340.Google ScholarPubMed
Dysken, M. W., Pandey, G. N. & Chang, S. S. (1979) Serial post-dexamethasone Cortisol levels in a patient undergoing ECT. American Journal of Psychiatry, 136, 1328–9.Google Scholar
Hafeli, W., Pieri, L., Pole, P. & Schaffner, R. (1981) General pharmacology and neuropharmacology of benzodiazepines derivates. Handbook of Experimental Pharmacology. Berlin: Springer Verlag.Google Scholar
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 5662.CrossRefGoogle ScholarPubMed
Holsboer, F., Klein, H., Bender, W. et al (1980) Hypothalamic—pituitary—adrenal activity in a group of 100 heterogenic patients: Diagnostic validity and biochemical aspects of the Cortisol response to dexamethasone suppression. In Progress in Neuropsychopharmacology, Twelfth Collegium Internationale Neuropsychopharmacologicum, (eds. Carlson, A., Engel, J., Gottfries, G. G. et al). New York: Pergamon Press.Google Scholar
Hwu, H., Rudorfer, M. V. & Clayton, P. J. (1981) Dexamethasone suppression test and subtypes of depression. Archives of General Psychiatry, 38, 363–7.CrossRefGoogle Scholar
Langer, G., Schonbeck, G., Koinig, G., Lesch, O., & Schussler, M. (1979) Hyperactivity of hypothalamic —pituitary—adrenal axis in endogenous depression. Lancet, 2, 524.CrossRefGoogle Scholar
Mendlewicz, J., Fleiss, J. L., Cataldo, M. & Rainer, J. D. (1975) The accuracy of the family history method in family studies of affective illness. Archives of General Psychiatry, 32, 309–14.CrossRefGoogle ScholarPubMed
Rudorfer, M. V., Hwu, H. G. & Clayton, P. J. (1982) Dexamethasone suppression test in primary depression: significance of family history and psychosis. Biological Psychiatry, 17, 41–8.Google ScholarPubMed
Rymer, J. C. (1978) Estimation of plasma Cortisol by radio-competition or radioimmunoassay. Use of commercial kits. Ann. Biol. Clin., 36, 509–14.Google ScholarPubMed
Schlesser, M. A., Winokur, G. & Sherman, B. M. (1980) Hypothalamic—pituitary—adrenal axis activity in depressive illness: its relationship to classification. Archives of General Psychiatry, 37, 737–43.CrossRefGoogle ScholarPubMed
Shulman, R. & Diewold, P. (1977) A two dose dexamethasone suppression test in patients with psychiatric illness. Canadian Psychiatric Association Journal, 22.CrossRefGoogle Scholar
Spitzer, R. L., Endicott, J. & Robbins, E. (1978) Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry, 35, 773–82.CrossRefGoogle ScholarPubMed
Winokur, G. (1979) Unipolar depression: is it divisible into autonomous subtypes? Archives of General Psychiatry, 36, 4752.CrossRefGoogle ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.