The dexamethasone suppression test as a predictor of suicidal behavior in unipolar depression

Yerevanian, Boghos I.; Feusner, Jamie D.; Koek, Ralph J.; Mintz, Jim

doi:10.1016/j.jad.2004.08.009

Cited by 90 publications

(49 citation statements)

References 29 publications

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“…In line with these results, studies from other groups also demonstrate that suicidal patients may display decreased levels of cortisol (Secunda et al, 1986;Pfennig et al, 2005). However, in contrast some studies indicate that HPA-hyperactivity is associated with suicidal behavior (Lopez-Ibor et al, 1985;Westrin and Nimeus, 2003) and completed suicide (Yerevanian et al, 2004;Coryell et al, 2006;Jokinen et al, 2007). As evident from the above, there is abundant evidence of a disturbed HPA-axis activity in suicide victims and attempters, and there is a great need for a more detailed understanding of these changes.…”

Section: Introductionmentioning

confidence: 67%

Salivary cortisol and suicidal behavior—A follow-up study

Lindqvist

Isaksson

Lil-Träskman-Bendz

et al. 2008

Psychoneuroendocrinology

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IntroductionHyperactivity of the Hypothalamic-Pituitary-Adrenal (HPA) axis is a common finding in Major DepressiveDisorder. Similar studies on suicide attempters are less abundant, and the results are divergent. The main aim of the present study was to investigate HPA-axis parameters by the time of a suicide attempt and at follow-up in search for associations between HPA axis function and suicidal behavior. MethodsThirty-five suicide attempters and 16 non-suicidal controls were admitted to a psychiatric ward between the years of 1986 an 1992. Corticotrophin-releasing hormone (CRH) in cerebrospinal fluid and urinary cortisol were obtained for the suicide attempters. The patients were followed up approximately 12 years after the index admission. Cortisol was measured in saliva, and additional suicide attempts and current psychiatric symptoms were registered. ResultsAt follow up, evening salivary cortisol was lower in suicide attempters compared to controls. Low cortisol levels at follow up were associated with severe psychiatric symptoms. Among women, repeated suicide attempts were associated with low morning and lunch salivary cortisol, and in this subgroup we also found significant correlations between salivary cortisol at follow up, and CRH as well as urinary cortisol at index. ConclusionWe found evidence for an association between low HPA axis activity and suicidal behavior. This could be due to long lasting and severe psychiatric morbidity, which in turn has exhausted the HPA axis of these patients. The potential role of hypocortisolism should be given more attention in studies on suicidal patients.

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Section: Introductionmentioning

confidence: 67%

Salivary cortisol and suicidal behavior—A follow-up study

Lindqvist

Isaksson

Lil-Träskman-Bendz

et al. 2008

Psychoneuroendocrinology

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“…Some reports have demonstrated dysfunction of the LHPA axis in suicidal patients with unipolar depression using the dexamethasone suppression test (DST) [12,36] . Yerevanian et al [37] demonstrated that the DST identifi ed unipolar depressed patients with a higher risk for future suicide completion or hospitalization for suicidality; in their study, 101 patients with major depressive disorder and/or dysthymic disorder were followed for 2 years after an initial DST. McLeod et al [2] suggest that areas of the brain with neuronal NO synthase and the LHPA axis have in common the production and the negative feedback of glucocorticoid, which is related to stress and depression.…”

Section: Discussionmentioning

confidence: 99%

Increased Plasma Nitric Oxide Metabolites in Suicide Attempters

Lee

Yoon

et al. 2006

Neuropsychobiology

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Objective: To evaluate any correlation between plasma levels of nitric oxide metabolites (NO_x) and suicide attempt. Method: Plasma NO_x levels were measured in 53 patients who had recently attempted suicide, 58 nonsuicidal psychiatric patients, and 75 normal controls. The severity of suicidal behaviors was evaluated using Weisman and Worden’s Risk-Rescue Rating Scale. Results: Plasma NO_x levels were significantly higher in suicidal patients than nonsuicidal psychiatric patients or normal control subjects (F = 11.029, d.f. = 2, 183, p < 0.001). Among the patients with a diagnosis of major depression, suicidal depressive patients had significantly higher plasma NO_x levels than nonsuicidal depressive patients (t = –3.090, d.f. = 84, p = 0.003). Conclusion: Our study suggests that increased NO production in plasma is associated with suicide attempt, especially in depressive patients.

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“…However, many studies of HPA axis function in bipolar disorder have not examined the potential effects of Suicidal Behavior (SB) (Cassidy et al, 1998;Cervantes et al, 2001;Cookson et al, 1985;Godwin, 1984;Linkowski et al, 1994;Rybakowski and Twardowska, 1999;Schmider et al, 1995) and studies of the association between HPA axis activity and suicidal behavior in varied diagnostic groups have had mixed results (Black et al, 2002;Coryell and Schlesser, 2001;Dahl et al, 1991;Duval et al, 2001;Jokinen and Nordström, 2008;Lindqvist et al, 2008;Pfennig et al, 2005;Pitchot et al, 2008;Tripodianakis et al, 2000;Yerevanian et al, 2004;Kamali et al, 2012).…”

Section: Risk Factors Associated With Biological Componentsmentioning

confidence: 99%