The Predictive Value of the Dexamethasone Suppression Test

Peselow, Eric D.; Stanley, Michael; Filippi, Ann-Marie; Barouche, Faouzia; Goodnick, Paul J.; Fieve, Ronald R.

doi:10.1192/s0007125000018171

Cited by 4 publications

(2 citation statements)

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“…1 Placebo Run-in for Antidepressant Trials 35 Feighner et al 1979;Goldberg and Finnerty 1980;Reimherr et al 1990;Rickels and Case 1982; Rowen et al 1982; Claghorn et al 1983;Hormazabal et al 1985; Irnlah 1985;Rickels et al 1985;Amsterdam et al 1986; Kleiser and Lehmann 1988;Spiker and Kupfer 1988Stewart et al 1981, 1985Veith et al 1982Jarvik et al 1983;Rickels et al 1985Agnew et al 1961Rothman et al 1962;Greenblatt et al 1964;Schildkraut et al 1964; British Medical Research Council 1965;Raskin et al 1978;Kellams et al 1979; Escobar et al 1980; Feighner 1980;Gerner et al 1980;Mann et al 1981;Rickels et al 1981; van der Velde 1981; Rickels et al 1982a,b;Veith et al 1982; Feighner et al 1983a,b; !til et al 1983;Jarvik et al 1983;Meredith and Feighner 1983a;Meredith et al 1984;Reimherr et al 1984; Liebowitz et al 1984a,b; Cohn and Wilcox 1985; Dominguez et al 1985;Kocsis et al 1985;Stark and Hardison 1985;Lipman et al 1986;Mendels and SchIess 1986; Wakelin 1986;Lapierre et al 1987;Rickels et al 1987; Byerley et al 1988;Liebowitz et al 1988;Quitkin et al 1988; Cohn et al. 1989; Conti and dell'Osso 1989; Elkin et al 1989; Feighner and Boyer 1989;Kocsis et al 1989;Lydiard et al 1989;Peselow et al 1989;…”

Section: Methods Of Metaanalysismentioning

confidence: 99%

Does a Placebo Run-In or a Placebo Treatment Cell Affect the Efficacy of Antidepressant Medications?

Trivedi

Rush

1994

Neuropsychopharmacol

168

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During the last decade, there has been an increasing use of a placebo run-in period prior to randomization to active treatments, or placebo in randomized controlled trials aimed at establishing acute phase antidepressant drug efficacy in patients with major depression. This procedure is thought to reduce response rates to placebo treatment after randomization, thereby increasing the drug-placebo difference. Metaanalyses of 101 studies reveal that a placebo run-in does not (1) lower the placebo response KEY WORDS: Depression; Placebo; Metaanalysis; Placebo run-in; Antidepressant medicationThe placebo run-in phase has become virtually stan dard practice in randomized controlled trials (RCTs) to test the efficacy of antidepressant medications in phase III and often phase IV studies. This single-blind phase usually lasts 3-14 days, followed by patients being ran domized to treatment. However, if patients show a meaningful symptomatic reduction (usually deflned as a20% to 25% improvement on a symptom rating scale), subjects are excluded from study. The implications of this practice have rarely been empirically evaluated.The rationale, based largely on intuition, is thought to reduce placebo responders post-randomization, thereby lowering post-randomization placebo response rates, and increasing differences between placebo and active treatments. Prien and Levine (1984) also sug- 655 Avenue of the Americas, New York, NY 10010 rate, (2) increase the drug-placebo difference, or (3) affect the drug response rate post-randomization in either inpatients or outpatients for any antidepressant drug group. If there is a post-randomization placebo treatment cell, drug response rates are unchanged or are slightly lower than if there is no placebo treatment cell for outpatients. These results suggest that a pill placebo run in provides no advantage in acute phase efficacy trials. [Neuropsychopharmacology 11:33-43, 1994J gested that the placebo run-in might eliminate rapid remitters, thereby reducing the need for post-randomiza tion placebo control treatment in some circumstances. The insuffi cient empirical data amassed to test these notions have not strongly supported the practice. Reim herr et al. (1989), in a retrospective reanalysiS, discov ered that the elimination of prerandomization placebo run-in "responders" reduced the drug-placebo differ ence from 30% to 25% in outpatients with major depres sion, and surprisingly, increased the placebo treatment response rates from 13% to 16%.Additional circumstantial data to question the value of this practice is from adult trials that have attempted to clinically characterize placebo responders. Outpa tients who "respond" during the placebo run-in tend to have longer episodes, a more chronic illness, a lower initial level of symptom severity, and are more likely nonendogenous. In comparison, patients who respond to placebo after randomization, tend to have shorter cur rent episodes and higher symptom severity at random ization (Fairchild et al. 1986;Rabkin et al. 1986Rabkin et al...

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Section: Methods Of Metaanalysismentioning

confidence: 99%

Does a Placebo Run-In or a Placebo Treatment Cell Affect the Efficacy of Antidepressant Medications?

Trivedi

Rush

1994

Neuropsychopharmacol

168

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“…These individuals re turned the next day for morning (8-9 a.m.) and after noon (4-5 p.m.) plasma cortisol [15], Suppressors (negative DST) w'ere defined as patients having both postdexamethasone plasma cortisols below 5 ug/dl. Nonsuppressors w'ere patients who had at least one of the two postdexamethasone plasma cortisols above 5 ug/dl.…”

Section: Dexamethasone Suppression Testmentioning

confidence: 99%

Depressive Attributional Style and the Dexamethasone Suppression Test: Relationship to the Endogenous/Melancholic Distinction and to Each Other

Peselow

Fieve

1992

Psychopathology

Self Cite

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The dexamethasone suppression test (DST) and the depressive attributional style questionnaire (ASQ) were administered to 105 depressed patients prior to participation in a double-blind outpatient study and to 29 normal controls. The depressed patients were classified into three groups (1) met criteria for both research diagnostic criteria for definite endogenous depression and DSM III melancholia; (2) met criteria for neither, and (3) met criteria for one but not both. The group that met criteria for both RDC endogenous depression and DSM-III melancholia had a statistically greater frequency of abnormal DST versus the group that met neither criteria and the normal controls. With regard to ASQ, patients who met both criteria had statistically higher bad event internality scores but statistically lower bad event stability and globality scores as opposed to the group that met neither criteria. In general, normal controls had significantly lower bad event ASQ scores than the three depressive groups. There was no correlation between ASQ and DST, as both DST suppressors and nonsuppressors had similar ASQ scores and there was no correlation between ASQ bad event attributions and initial severity of depression.

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The HPA Axis and Depressive Disorders

Haskett

1993

Biology of Depressive Disorders. Part A

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The Predictive Value of the Dexamethasone Suppression Test

Cited by 4 publications

References 24 publications

Does a Placebo Run-In or a Placebo Treatment Cell Affect the Efficacy of Antidepressant Medications?

Does a Placebo Run-In or a Placebo Treatment Cell Affect the Efficacy of Antidepressant Medications?

Depressive Attributional Style and the Dexamethasone Suppression Test: Relationship to the Endogenous/Melancholic Distinction and to Each Other

The HPA Axis and Depressive Disorders

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