Dexamethasone suppression test and TRH test in endogenous depression

Abstract

Dexamethasone suppression test (DST) and thyrotropin releasing hormone (TRH) stimulation test were performed in 34 patients with endogenous depression. Compared with 33 psychiatric controls (limit of discrimination for serum cortisol of 275 nmol/l = 10 micrograms/100 ml) the specificity of the DST was 91% and the sensitivity was 65%. Compared with 24 healthy subjects the sensitivity of the TRH test was 24%, and the combined sensitivity for the DST and the TRH test was 76%. In contrast to the TRH test the DST showed a significant relationship (r = 0.54, P less than 0.01) to the Hamilton Rating Score. Repeating the tests after clinical recovery parallel changes of the two tests were found in 14 of 19 patients with abnormal DST in the depressed phase. In the remaining five patients the DST normalized, while the TRH test remained unchanged. It is suggested that both the apparent higher diagnostic sensitivity and the higher rate of normalization after clinical recovery of the DST is due to the dependency of the severity of depression.

Results of the 8 a.m. Dexamethasone Suppression Test Constitute a Suitable Tool for Confirming the Diagnosis of Melancholia

“…These findings are in accordance with those of other authors [Holsboer et al, 1982;Aggernaes et al, 1983;Maes et al, 1986aMaes et al, , b, 1987, Also, we found a significant relation between age and the postdexamethasone values at 8 a.m. However only 2.2% of the variance in the DST results could be explained by age effects.…”

Thyroid hormones in the treatment of affective disorders

“…Others have focused on abnormalities in the self-regulation of catecholaminergic systems in the case of thyroid dysfunction (35). Some studies have found hypothyroidism, either clinical or subclinical, in some rapid cycling affective patients (18,(120)(121)(122)(123)126). Some studies have found hypothyroidism, either clinical or subclinical, in some rapid cycling affective patients (18,(120)(121)(122)(123)126).…”

“…Several hypotheses have been suggested to explain the stabilizing effect of thyroid hormones on rapid cycling, but the exact mechanism still remains obscure (1 18,131). Some have associated the deficiency of thyroid hormones with dysfunction in the periodicity of various biological rhythms responsible for the stabilization of mood (1 18).…”

“…Although early studies have found changes in thyroid functions in depression (15), recent studies, using more sensitive and accurate assessments of thyroid functions, generally report that most depressed patients are euthyroid (16,17). However, approximately a quarter of depressed patients show a decreased TSH response to the administration of TRH (16,18), compared with 0%-4% of the normal population (17,19). At least in some depressed patients, the blunted TSH response returns to normal with.remission (20,21).…”

Cortisol response to dexamethasone and noradrenergic function in depression

“…A proportion (35 to 60 per cent) of patients with major depression show a disturbed DST (1)(2)(3)(4)(8)(9)(10). Some authors have found that patients with major depression exhibit a disturbed MHPG excretion (11)(12).…”