Use of the dexamethasone suppression test in an inpatient setting: A replication and new findings

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

“…The observed increments in the postdexamethasone cortisol values in major depressives with melancholia and/or with psychotic features as compared with normal controls and with minor depressives consolidate earlier reports [Carroll, 1980;Feinberg and Carroll, 1984;Evans et al, 1983;Zimmerman et al, 1985;Maes et al, 1986aMaes et al, , 1989a. These biological differences between se verely depressed patients and normal controls or minor depressives were significant to the extent that criteria assigned to the cortisol values permitted a good discrim ination of those groups.…”

“…A large variation in the bioavailability of dexa methasone was observed after oral administration [Meikle, 1982;Lowy and Meltzer, 1987] and due to either inadequate decreased or inappropriately high dexameth asone values the DST results were unsatisfactory in at least 20% of the subjects [Meikle, 1982], Some [Lewis et al, 1984;Halbreich et al, 1984;Stokes et al, 1984;Stangl et al, 1986] but not all authors [Caroff et al, 1983;Klein et al, 1984;Syvalahti, 1985] found that age substantially contributed to cortisol es cape from suppression by dexamethasone. Most studies agree that there are no gender-related differences in the DST results [Evans et al, 1983;Klein et al, 1984;Maes et al, 1986aMaes et al, , 1989a.…”

“…Consequently, on the one hand most authors used overinclusive criteria for the 8 a.m., 4 p.m. and 11 p.m. cortisol values combined in parallel, and on the other hand too restrictive criteria for the 8 a.m. postdexamethasone cortisol values. However, the findings of Maes et al [1986aMaes et al [ , 1989a were not yet vali dated for the dichotomy major depression with associ ated features versus normal controls.…”

“…However, Maes et al [1986aMaes et al [ , 1989a found that the 8 a.m. postdexa methasone cortisol values 2* 3.5 pg/dl constituted a more sensitive and specific clinical tool for confirming the diagnosis of major depression and melancholia as compared to the 4 p.m. values and to the several cortisol values in parallel. Moreover, Maes et al [1986aMaes et al [ , 1989a found that the 4 p.m. cortisol values yielded the most suitable separation of major from minor depression us ing a break point ^ 6 pg/dl whereas 2* 8 pg/dl was the best cutoff point for the combination in parallel of the three cortisol values. Consequently, on the one hand most authors used overinclusive criteria for the 8 a.m., 4 p.m. and 11 p.m. cortisol values combined in parallel, and on the other hand too restrictive criteria for the 8 a.m. postdexamethasone cortisol values.…”

“…Failure to suppress plasma cortisol with the 1-mg dexamethasone suppression test (DST) has repeatedly been reported in major depressed patients [Carroll, 1980[Carroll, , 1982Brown and Shuey, 1980;Coppen et al, 1983;Feinberg and Carroll, 1984;Maes et al, 1986aMaes et al, , 1989a, Several studies showed that the DST may help con firm the diagnosis of major depression and distinguish that disorder from normal controls [Carroll et al, 1981] or from minor dépressives [Maes et al, 1986a[Maes et al, , 1989a. The postdexamethasone cortisol values at 8 a.m., 4 p.m. and 11 p.m. in parallel (anyone of the values showing nonsuppression) [Brown and Shuey, 1980;Carroll et al, 1981;Syvalahti, 1985] or the cortisol values at 4 p.m. only [Giles and Rush, 1982;Klein et al, 1984] at a threshold value 5= 5 pg/dl were recommended for this value of the DST for melancholia was not affected by the purpose.…”