Dexamethasone suppression test and selection of antidepressant medications

Greden, John F.; Kronfol, Ziad; Gardner, Robert; Feinberg, Michael; Mukhopadhyay, Sunil; Albala, A. Ariav; Carroll, Bernard J.

doi:10.1016/0165-0327(81)90007-0

Cited by 38 publications

(9 citation statements)

References 20 publications

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“…The association of DSTN with somatic complaints may point to DSTN as an unspecific stress phenomenon more exactly reflecting the type of stress response pattern, which is mainly characterized by increased activity of the pituitaryadrenal cortical system (28). On the other hand, it has been shown that the DST has predictive properties for treatment response with antidepressants (21,29,30,31,32,33,34), sleep deprivation (35,36), and electroconvulsive treatment (37,38,39). This gives some hint that specific biochemical disturbances might be expressed by a decreased ability for dexamethasone suppression that are then specifically counteracted by certain tricyclics, ECT and sleep deprivation.…”

Section: Discussionmentioning

confidence: 93%

Dexamethasone suppression test in a pluri‐diagnostic approach: its relationship to psychopathological and clinical variables

Kasper¹,

Beckmann²

1983

Acta Psychiatr Scand

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Using a pluridiagnostic approach, the dexamethasone suppression test (DST) was studied in 67 depressed inpatients in its relationship to diverse clinical variables. The International Classification of Diseases (ICD), the Research Diagnostic Criteria (RDC), the Newcastle Index, the Hamilton Depression Rating scale (HAM-D), and the Bf-s self rating questionnaire were applied. Fifty-two per cent of endogenous depressed (ICD), 51% of major depressive (RDC) and 53% of endogenous depressed (Newcastle) patients demonstrated dexamethasone nonsuppression (DSTN) with a value above 110 nm/l. Six per cent of neurotic depressed (ICD), 9% of minor depressive (RDC) and 23% of neurotic depressed (Newcastle) patients were dexamethasone nonsuppressors. Significantly higher values (after P-correction) for DSTN could be detected in severity ratings as measured with Newcastle (P less than 0.001) and HAM-D global score (P less than 0.001) and also for HAM-D factor 4 (somatic complaints, P = 0.001). All the other evaluated variables did not discriminate between patients with dexamethasone suppression and with nonsuppression.

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Section: Discussionmentioning

confidence: 93%

Dexamethasone suppression test in a pluri‐diagnostic approach: its relationship to psychopathological and clinical variables

Kasper¹,

Beckmann²

1983

Acta Psychiatr Scand

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“…The initial study examining the relation ship of the DST to antidepressant drugs was done by McLeod et al [16], They noted that 6 nonsuppressors had a poor response to either imipramine or tranylcypromine, whereas 10 suppressors all had positive responses to the aforementioned antidepressants. More recent retrospective work [7,8,17] suggests that a positive DST (nonsuppressor) has a high rate of response to somatic therapy, whereas those with a negative DST had a low re sponse to varied somatic therapy [7,8].…”

Section: Discussionmentioning

confidence: 99%

Dexamethasone Suppression Test in Predicting Response to Tricyclic Antidepressants in Depressed Outpatients

Peselow

Goldring²,

Barouche

et al. 1985

Psychopathology

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75 outpatients who presented to an affective disorder clinic received the dexamethasone suppression test (DST). Following 1 week observation, and following 1 week on low-dose imipramine HCl, all patients who remained depressed (Hamilton score 16 or greater) were given a full clinical trial of imipramine HCl (150–300 mg/day) over a minimum 3- to 5-week period. Of the 45 patients who required this trial and who received imipramine HCl for at least 3 weeks, there was no relationship between DST suppression or nonsuppression vs. clinical response to imipramine HCl. There was a statistically significant trend for suppressors (negative DST) to respond either spontaneously or to low-dose imipramine HCl as opposed to nonsuppressors (positive DST).

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“…Cortisol receptors are widely distributed in the brain, especially in the hippocampus, amygdala and hypothalamus 35 -areas that are also impaired in MDD. In fact, there is convincing evidence from basic and clinical studies of overactivity of HPA axis among depressed subjects -e.g., high cortisol serum levels in depressed subjects 36 ; and exaggerated cortisol increasing after the dexamethasone supression test 37 . Along these lines, recent evidence suggests a moderate role for steroid hormones in the antidepressant efficacy of TMS; i.e., cortisol and other hormones can impair cortical activity in the brain (especially in those areas with high levels of steroid receptors) thus leading to a more severe, "endogenous" depression 38 .…”

Section: Pathophysiologymentioning

confidence: 99%

Neuromodulation approaches for the treatment of major depression: challenges and recommendations from a working group meeting

Brunoni

Teng

Correa³

et al. 2010

Arq. Neuro-Psiquiatr.

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The use of neuromodulation as a treatment for major depressive disorder (MDD) has recently attracted renewed interest due to development of other non-pharmacological therapies besides electroconvulsive therapy (ECT) such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), deep brain stimulation (DBS), and vagus nerve stimulation (VNS). Method: We convened a working group of researchers to discuss the updates and key challenges of neuromodulation use for the treatment of MDD. results: The state-of-art of neuromodulation techniques was reviewed and discussed in four sections: [1] epidemiology and pathophysiology of MDD; [2] a comprehensive overview of the neuromodulation techniques; [3] using neuromodulation techniques in MDD associated with non-psychiatric conditions; [4] the main challenges of neuromodulation research and alternatives to overcome them. Discussion: ECT is the first-line treatment for severe depression. TMS and tDCS are strategies with a relative benign profile of side effects; however, while TMS effects are comparable to antidepressant drugs for treating MDD; further research is needed to establish the role of tDCS. DBS and VNS are invasive strategies with a possible role in treatment-resistant depression. In summary, MDD is a chronic and incapacitating condition with a high prevalence; therefore clinicians should consider all the treatment options including invasive and non-invasive neuromodulation approaches. Key words: comprehensive review, major depressive disorder, ECT, TMS, clinical guidelines.Estratégias de neuromodulação para o tratamento da depressão maior: desafios e recomendações de uma força-tarefa rEsuMo O uso de técnicas de neuromodulação para o tratamento do transtorno depressivo maior (TDM) tem despertado um renovado interesse nos últimos anos com o desenvolvimento de outras intervenções não-farmacólogicas além da eletroconvulsoterapia (ECT), como a estimulação magnética transcraniana (EMT), a estimulação transcraniana por corrente continua (ETCC), a estimulação cerebral profunda (DBS) e a estimulação de nervo vago (VNS). Método: Nós organizamos um grupo de trabalho com vários pesquisadores para discutir os avanços recentes e os principais desafios para o uso da neuromodulação no tratamento os principais desafios da pesquisa na neuromodulação e alternativas para superá-los. Discussão: ECT é o tratamento de primeira linha para depressão grave. EMT e ETCC são estratégias com um perfil benigno de efeitos adversos; contudo, enquanto os efeitos da EMT são comparáveis ao das drogas antidepressivas para o tratamento da TDM, a eficácia da ETCC ainda precisa ser estabelecida por mais pesquisas clínicas. DBS e VNS são intervenções invasivas com um papel possível para a depressão refratária. Em resumo, TDM é uma condição crônica, incapacitante e de alta prevalência; portanto na prática clínica todas as opções de tratamento possíveis, incluindo as farmacológicas e não-farmacológicas, devem ser consideradas. Palavras-chave: artigo de revisão, tra...

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Dexamethasone suppression test and selection of antidepressant medications

Cited by 38 publications

References 20 publications

Dexamethasone suppression test in a pluri‐diagnostic approach: its relationship to psychopathological and clinical variables

Dexamethasone suppression test in a pluri‐diagnostic approach: its relationship to psychopathological and clinical variables

Dexamethasone Suppression Test in Predicting Response to Tricyclic Antidepressants in Depressed Outpatients

Neuromodulation approaches for the treatment of major depression: challenges and recommendations from a working group meeting

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