Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-27T09:57:38.417Z Has data issue: false hasContentIssue false
  • English
  • Français

Endocrine changes and clinical profiles in depression: I. The dexamethasone suppression test

Published online by Cambridge University Press:  09 July 2009

S. P. Calloway ,
R. J. Dolan ,
P. Fonagy ,
V. F. A. De Souza  and
A. Wakeling
S. P. Calloway*
Affiliation:
From the Academic Department of Psychiatry, Royal Free Hospital, London
R. J. Dolan
Affiliation:
From the Academic Department of Psychiatry, Royal Free Hospital, London
P. Fonagy
Affiliation:
From the Academic Department of Psychiatry, Royal Free Hospital, London
V. F. A. De Souza
Affiliation:
From the Academic Department of Psychiatry, Royal Free Hospital, London
A. Wakeling
Affiliation:
From the Academic Department of Psychiatry, Royal Free Hospital, London
*
1 Address for correspondence: Dr S. P. Calloway, Academic Department of Psychiatry, Royal Free Hospital, Pond Street, London NW3 2QG.
Get access Rights & Permissions [Opens in a new window]

Synopsis

Hypothalamic–pituitary–adrenal axis function was investigated in 72 patients with primary depression. Forty-four per cent of the patients demonstrated abnormal suppression of their cortisol levels after a 1 mg overnight dexamethasone suppression test. Patients with abnormal suppression (‘non-suppressors’) were not clearly distinguished from ‘suppressors’ by the commonly used diagnostic classifications. They did not appear to be more severely depressed, but they were more likely than the ‘suppressors’ to be in-patients. Multivariate analysis of the data suggested that two clinical features were independently associated with non-suppression: the PSE syndromes of Slowness and General Anxiety. However, the association of these syndromes with non-suppression was relatively weak, indicating that the clinical significance of the dexamethasone suppression test is, as yet, unclear. The results raise doubts about the validity of using the dexamethasone suppression test as a diagnostic marker for a specific depressive syndrome.

Type
Research Article
Information
Psychological Medicine , Volume 14 , Issue 4 , November 1984 , pp. 749 - 758
Copyright
Copyright © Cambridge University Press 1984

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aggernaes, H., Kirkegaard, C., Krog-Meyer, I., Kijne, B., Larsen, J. K., Laursen, A. L., Lykke-Olesen, L., Mikkelsen, P. L., Rasmussen, S. & Bjørum, N. (1983). Dexamethasone suppression test and TRH test in endogenous depression. Acta Psychiatrica Scandinavica 67, 258–264.CrossRefGoogle ScholarPubMed
Agren, H. & Wide, L. (1982). Patterns of depression reflected in pituitary–thyroid and pituitary–adrenal endocrine changes. Psychoneuroendocrinology 7, 309–327.CrossRefGoogle ScholarPubMed
Amsterdam, J. D., Winokur, A., Caroff, S. N. & Conn, J. (1982). The dexamethasone suppression test in out-patients with primary affective disorder and healthy control subjects. American Journal of Psychiatry 139, 287–291.Google ScholarPubMed
Beary, M. D., HubertLacey, J. Lacey, J. & Bhat, A. V. (1983). The neuro-endocrine impact of 3-hydroxy-diazepam (temazepam) in women. Psychopharmacology 79, 295–297.CrossRefGoogle ScholarPubMed
Berger, M., Doerr, P., Lund, R., Bronisch, T. & von Zerssen, D. (1982). Neuroendocrinological and neurophysiological studies in major depressive disorders: are there biological markers for the endogenous subtype? Biological Psychiatry 17, 1217–1242.Google ScholarPubMed
Blumer, D., Zorick, F., Heilbronn, M. & Roth, T. (1982). Biological markers for depression in chronic pain. Journal of Nervous and Mental Disease 170, 425–428.CrossRefGoogle ScholarPubMed
Board, F., Wadeson, R. & Persky, H. (1957). Depressive affect and endocrine functions. Blood levels of adrenal cortex and thyroid hormones in patients suffering from depressive reactions. Archives of Neurology and Psychiatry 78, 612.CrossRefGoogle ScholarPubMed
Brown, G. W. & Harris, T. (1978). Social Origins of Depression. Tavistock: London.Google ScholarPubMed
Brown, M. B. & Forsythe, A. B. (1974). The small sample behaviour of some statistics which test the equality of several means. Technometrics 16, 129–132.CrossRefGoogle Scholar
Brown, W. A. & Shuey, I. (1980). Response to dexamethasone and subtype of depression. Archives of General Psychiatry 37, 747–751.CrossRefGoogle ScholarPubMed
Brown, W. A., Johnston, R. & Mayfield, D. (1979). The 24-hour dexamethasone suppression test in a clinical setting: relationship to diagnosis, symptoms and response to treatment. American Journal of Psychiatry 136, 543–547.CrossRefGoogle Scholar
Brown, W. A., Haier, R. J. & Qualls, C. B. (1980). Dexamethasone suppression test identifies subtypes of depression which respond to different antidepressants. Lancet i, 928–929.CrossRefGoogle Scholar
Butler, P. W. P. & Besser, G. M. (1968). Pituitary–adrenal function in severe depressive illness. Lancet ii, 1234–1236.CrossRefGoogle Scholar
Butler, P. W. P., Besser, G. M. & Steinberg, H. (1968). Changes in plasma cortisol induced by dexamphetamine and chlordiazepoxide given alone and in combination in man. Journal of Endocrinology 40, 391–392.CrossRefGoogle ScholarPubMed
Calloway, S. P., Dolan, R. J., Fonagy, P., De Souza, V. F. A. & Wakeling, A. (1984). Endocrine changes and clinical profiles in depression: II. The thyrotropin-releasing hormone test. Psychological Medicine 14, 759–765.CrossRefGoogle ScholarPubMed
Carney, M. W. P., Roth, M. & Garside, R. F. (1965). The diagnosis of depressive syndromes and the prediction of ECT response. British Journal of Psychiatry 111, 659–674.CrossRefGoogle Scholar
Carroll, B. J. (1976). Limbic system-adrenal cortex regulation in depression and schizophrenia. Psychosomatic Medicine 38, 106–119.CrossRefGoogle ScholarPubMed
Carroll, B. J. (1980). Clinical application of neuroendocrine research in depression. In Handbook of Biological Psychiatry, Vol. 3 (ed. Van Praag, H. M., Lader, M. H., Rafaelson, O. J. and Sachar, E. J.), pp. 179–193. Marcel Dekker: New York.Google Scholar
Carroll, B. J. (1982). The dexamethasone suppression test for melancholia. British Journal of Psychiatry 140, 292–304.CrossRefGoogle ScholarPubMed
Carroll, B. J. & Curtis, G. C. (1976). Neuroendocrine identification of depressed patients. Australian and New Zealand Journal of Psychiatry 10, 13–20.CrossRefGoogle ScholarPubMed
Carroll, B. J., Martin, F. I. R. & Davies, B. M. (1968). Resistance to suppression by dexamethasone of plasma 11-OHCS levels in severe depressive illness. British Medical Journal iii, 287.Google Scholar
Carroll, B. J., Curtis, G. C. & Mendels, J. (1976). Neuroendocrine regulation in depression. I. Limbic system-adreno-cortical dysfunction. Archives of General Psychiatry 33, 1039–1044.CrossRefGoogle ScholarPubMed
Carroll, B. J., Feinberg, M., Greden, J. F., Tarika, J., Albala, A. A., Haskett, R. F., James, N. Mcl., Kronfol, Z., Lohr, N., Steiner, M., De Vigne, J. P. & Young, E. (1981). A specific laboratory test for the diagnosis of melancholia. Archives of General Psychiatry 38, 15–22.CrossRefGoogle ScholarPubMed
Davis, K. L., Hollister, L. E., Mathe, A. A., Davis, J. M., Rothpearl, A. B., Faull, K. F., Hsieh, J. Y. K., Barchas, J. D. & Berger, P. A. (1981). Neuroendocrine and neurochemical measurements in depression. American Journal of Psychiatry 138, 1555–1562.Google ScholarPubMed
Feinberg, M. & Carroll, B. J. (1982). Separation of subtypes of depression using discriminant analyses. British Journal of Psychiatry 140, 384–391.CrossRefGoogle Scholar
Gerner, R. H. & Gwirtsman, H. E. (1981). Abnormalities of dexamethasone suppression test and urinary MHPG in anorexia nervosa. American Journal of Psychiatry 138, 650–653.Google ScholarPubMed
Gibbons, J. L. & McHugh, P. R. (1962). Plasma cortisol in depressive illness. Journal of Psychiatric Research 1, 162–171.CrossRefGoogle ScholarPubMed
Gibbons, J. L., Gibson, J. G., Maxwell, A. E. & Wilcox, D. R. C. (1960). An endocrine study of depressive illness. Journal of Psychiatric Research 1, 162–171.CrossRefGoogle Scholar
Goodwin, F. K. & Bunney, W. E. (1973). A psychobiological approach to affective illness. Psychiatric Annals 3, 19–53.CrossRefGoogle Scholar
Greden, J. F., Kronfol, Z., Gardner, R., Feinberg, M., Mukhopadhyay, S., Albala, A. & Carroll, B. J. (1981). Dexamethasone suppression test and selection of antidepressant medications. Journal of Affective Disorders 3, 389–396.CrossRefGoogle ScholarPubMed
Hamilton, M. (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology 6, 278–296.CrossRefGoogle ScholarPubMed
Hirschfield, R. M. A. (1981). Situational depression: validity of the concept. British Journal of Psychiatry 139, 297–305.CrossRefGoogle Scholar
Holden, N. L. (1983). Depression and the Newcastle Scale. Their relationship to the dexamethasone suppression test. British Journal of Psychiatry 142, 505–507.CrossRefGoogle Scholar
Holsboer, F., Bender, W., Benkert, O., Klein, H. E. & Schmauss, M. (1980). Diagnostic value of dexamethasone suppression test in depression. Lancet ii, 706.CrossRefGoogle Scholar
Hudson, J. I., Laffer, P. S. & Pope, H. S. (1982). Bulimia related to affective disorder by family history and response to the dexamethasone suppression test. American Journal of Psychiatry 139, 685–687.Google Scholar
Jennrich, R. I. (1977). Stepwise discriminant analysis. In Statistical Methods for Digital Computers (ed. Enslein, K., Ralston, A. and Wilf, H. S.), pp. 76–95. Wiley: New York.Google Scholar
Krieger, D. T., Allen, W., Rizzo, F. & Krieger, H. P. (1971). Characterisation of the normal temporal pattern of plasma corticosteroid levels. Journal of Clinical Endocrinology and Metabolism 32, 266–284.CrossRefGoogle ScholarPubMed
Lachenbruch, P. & Mickey, R. M. (1968). Estimation of error rates in discriminant analysis. Technometrics 10, 1–11.CrossRefGoogle Scholar
Langer, G., Schonbeck, G., Koinig, G., Lesch, O. & Schussler, M. (1979). Hyperactivity of hypothalamic–pituitary–adrenal axis in endogenous depression. Lancet ii, 524.CrossRefGoogle Scholar
Leach, C. (1979). Introduction to Statistics. A Non-parametric Approach for the Social Sciences. Wiley: Chichester.CrossRefGoogle Scholar
Mason, J. W. (1968). A review of psychoendocrine research on the pituitary–adrenal cortical system. Psychosomatic Medicine 30, 576–607.CrossRefGoogle ScholarPubMed
Meltzer, H. Y. & Fang, V. S. (1983). Cortisol determination and the dexamethasone suppression test. Archives of General Psychiatry 40, 501–505.CrossRefGoogle ScholarPubMed
Mendlewicz, J., Charles, G. & Franckson, J. M. (1982). The dexamethasone suppression test in affective disorder: relationship to clinical and genetic subgroups. British Journal of Psychiatry 141, 464–470.CrossRefGoogle ScholarPubMed
Murray, D. (1967). Cortisol binding to plasma proteins in man in health, stress and at death. Journal of Endocrinology 39, 571–591.CrossRefGoogle ScholarPubMed
Nuller, J. L. & Ostroumova, M. N. (1980). Resistance to inhibiting effect of dexamethasone in patients with endogenous depression. Acta Psychiatrica Scandinavica 61, 169–177.CrossRefGoogle ScholarPubMed
Peselow, E. D., Goldring, N., Fieve, R. R. & Wright, R. (1983). The dexamethasone suppression test in depressed outpatients and normal control subjects. American Journal of Psychiatry 140, 245–247.Google ScholarPubMed
Platman, S. R. & Fieve, R. R. (1968). Lithium carbonate and plasma cortisol response in the affective disorders. Archives of General Psychiatry 18, 591–594.CrossRefGoogle Scholar
Reus, V. I. (1982). Pituitary–adrenal disinhibition as the independent variable in the assessment of behavioural symptoms. Biological Psychiatry 17, 317–326.Google Scholar
Sachar, E. J. (1967). Corticosteroids in depressive illness: II. A longitudinal psychoendocrine study. Archives of General Psychiatry 17, 554–567.CrossRefGoogle Scholar
Sachar, E. J., Hellman, L., Fukushima, D. K. & Gallagher, T. F. (1970). Cortisol production in depressive illness. A clinical and biochemical clarification. Archives of General Psychiatry 23, 289–298.CrossRefGoogle ScholarPubMed
Sachar, E. J., Hellman, L., Roffwarg, H. P., Halpern, F. X., Howard, P., Halpern, F. S., Fukushima, D. K. & Gallagher, T. F. (1973). Disrupted 24-hour patterns of cortisol secretion in psychotic depressives. Archives of General Psychiatry 28, 19–24.CrossRefGoogle Scholar
Shulman, M. B. & Diewold, P. (1977). A two-dose dexamethasone suppression test in patients with psychiatric illness. Canadian Psychiatric Association Journal 22, 417–422.CrossRefGoogle Scholar
Spar, J. E. & Gerner, R. (1982). Does the dexamethasone suppression test distinguish dementia from depression? American Journal of Psychiatry 139, 238–240.Google ScholarPubMed
Spitzer, R. L., Endicott, J. & Robins, E. (1978). Research diagnostic criteria. Rationality and reliability. Archives of General Psychiatry 35, 773–782.CrossRefGoogle Scholar
Stokes, P. E., Stoll, P. M., Mattson, M. R. & Sollod, R. N. (1976). Diagnosis and psychopathology in psychiatric patients resistant to dexamethasone. In Hormones, Behaviour, and Psychopathology (ed. Sachar, E. J.), pp. 225–229. Raven Press: New York.Google Scholar
Suwa, N., Yamashita, I., Moroji, K., Yamazaki, F., Okada, Y., Saito, Y., Asano, Y. & Fujieda, T. (1974). Circadian rhythm of plasma cortisol in endogenous psychoses. In Psychoneuroendocrinology, (ed. Hatotami, N.), pp. 4–12. S. Karger: Basel.Google Scholar
Targum, S. D., Sullivan, A. C. & Byrnes, S. M.(1982). Neuroendocrine interrelationships in major depressive disorder. American Journal of Psychiatry 139, 282–286.Google ScholarPubMed
Wilens, T. E., Arana, G. W., Baldessarini, R. J. & Cremens, C. (1983). Comparison of solid-phase radioimmunoassay and competitive protein binding method for postdexamethasone cortisol levels in psychiatric patients. Psychiatry Research 8, 199–206.CrossRefGoogle ScholarPubMed
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974). The Measurement and Classification of Psychiatric Symptoms. Cambridge University Press: Cambridge.Google Scholar
Wing, J. K., Mann, S. A., Leff, J. P. & Nixon, J. M. (1978). The concept of a ‘case’ in psychiatric population surveys. Psychological Medicine 8, 203–217.CrossRefGoogle ScholarPubMed
Winokur, G. (1979). Unipolar depression: is it divisible into autonomous subtypes? Archives of General Psychiatry 36, 47 52.CrossRefGoogle ScholarPubMed
Wood, K., Harwood, S. & Coppen, A. (1983). Technique and accuracy of the dexamethasone suppression test. Archives of General Psychiatry 40, 585.CrossRefGoogle Scholar