Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-22T16:17:35.290Z Has data issue: false hasContentIssue false
  • English
  • Français

The Dexamethasone Suppression Test for Melancholia

Published online by Cambridge University Press:  29 January 2018

Bernard J. Carroll
Bernard J. Carroll*
Affiliation:
Mental Health Research Institute; Acting Chairman, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, U.S.A.
Get access Rights & Permissions [Opens in a new window]

Summary

Melancholia is thought by many investigators to have a biological basis, and biological research, particularly on abnormalities of the neuroendocrine system and of the sleep electroencephalogram, is now beginning to yield results which can help in the differential diagnosis of depressive illness. This review will focus on the most widely studied neuroendocrine disturbance: disinhibition of the hypothalamus-pituitary-adrenal cortex (HPA) system as revealed by the dexamethasone suppression test (DST).

Type
Research Article
Information
The British Journal of Psychiatry , Volume 140 , Issue 3 , March 1982 , pp. 292 - 304
Copyright
Copyright © Royal College of Psychiatrists, 1982 

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

Akiskal, H. S., Djenderedjian, A. M., Rosenthal, R. H. et al (1977) Cyclothymic disorder: validating criteria for inclusion in the bipolar affective group. American Journal of Psychiatry, 134, 1227–33.Google ScholarPubMed
Akiskal, H. S., Rosenthal, T. L., Haykal, R. F. et al (1980) Characterological depressions. Archives of General Psychiatry, 37, 778–83.Google Scholar
Akiskal, H. S., Rosenthal, R. H., Rosenthal, T. L. et al (1979) Differentiation of primary affective illness from situational, symptomatic and secondary depressions. Archives of General Psychiatry, 36, 635–43.CrossRefGoogle ScholarPubMed
Albala, A. A., Greden, J. F., Tarika, J. & Carroll, B. J. (1981) Changes in serial dexamethasone suppression tests among unipolar depressives receiving electroconvulsive treatment. Biological Psychiatry, 16, 551–60.Google ScholarPubMed
Andrews, G., Kiloh, L. & Nielson, M. (1973) Patterns of depressive illness: the compatibility of disparate points of view. Archives of General Psychiatry, 29, 670–3.CrossRefGoogle ScholarPubMed
Berger, M., Doerr, P., Lund, R., von Zerssen, D. et al (1980) Modification of the dexamethasone suppression test and the REM-latency by physostigmine in normal and depressed patients. 12th CINP Congress, Progress in Neuro-Psychopharmacology, Suppl, Abstract 58, p 78.Google Scholar
Brawley, P. (1979) Dexamethasone, methylphenidate and depression. American Psychiatric Association Scientific Proceedings, Abstract 161, p 352.Google 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, 928–9.Google Scholar
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, 543–7.CrossRefGoogle Scholar
Brown, W. A. & Shuey, I. (1980) Response to dexamethasone and subtype of depression. Archives of General Psychiatry, 37, 747–51.Google Scholar
Buckingham, J. C. & Hodges, J. R. (1977) Production of corticotrophin releasing hormone by the isolated hypothalamus of the rat. Journal of Physiology, 272, 469–79.CrossRefGoogle ScholarPubMed
Carman, J. S., Hall, K., Wyatt, E. S. & Crews, E. L. (1980) Dexamethasone non-suppression: predictor of thymoleptic response in catatonic and schizoaffective patients. Society of Biological Psychiatry Scientific Proceedings, Abstract 4, p 36.Google Scholar
Carroll, B. J. (1972) The hypothalamic-pituitary-adrenal axis in depression. In Depressive Illness: Some Research Studies (eds. Davies, B., Carroll, B. J. and Mowbray, R. M.), pp 23–201. Springfield, Illinois: C. C. Thomas.Google Scholar
Carroll, B. J. (1976) Limbic system-pituitary-adrenal cortex regulation in depression and schizophrenia. Psychosomatic Medicine, 38, 106–21.CrossRefGoogle ScholarPubMed
Carroll, B. J. (1977) The hypothalamus-pituitary-adrenal axis in depression. In Handbook on Depression (ed. Burrows, G.), pp 325–41. Amsterdam: Excerpta Medica.Google Scholar
Carroll, B. J. (1978) Neuroendocrine function in psychiatric disorders. In Psychopharmacology: A Generation of Progress (eds. Lipton, M. A., DiMascio, A. and Killam, K. F.), pp 487–97. New York: Raven Press.Google Scholar
Carroll, B. J. (1979a) Prediction of treatment outcome with lithium. Archives of General Psychiatry, 36, 870–8.Google Scholar
Carroll, B. J. (1979b) Neuroendocrine function in mania. In Manic Illness: A Profile in Psychobiological Research (ed. Shopsin, B.), pp 163–76. New York: Raven Press.Google Scholar
Carroll, B. J. (1980) Implications of biological research for the diagnosis of depression. In New Advances in the Diagnosis and Treatment of Depressive Illness (ed. Mendlewicz, J.), pp 85–107. Amsterdam: Excerpta Medica.Google Scholar
Carroll, B. J., Curtis, G. C. & Mendels, J. (1976a) Neuroendocrine regulation in depression. I. Limbic system-adreno-cortical dysfunction. Archives of General Psychiatry, 33, 1039–44.CrossRefGoogle ScholarPubMed
Carroll, B. J., Curtis, G. C. & Mendels, J. (1976b) Neuroendocrine regulation in depression. II. Discrimination of depressed from non-depressed patients. Archives of General Psychiatry, 33, 1051–7.Google Scholar
Carroll, B. J. & Davies, B. M. (1970) Clinical associations of 11-hydroxycorticosteroid suppression and non-suppression in severe depressive illness. British Medical Journal, i, 789–91.Google Scholar
Carroll, B. J., Feinberg, M., Greden, J. F. et al (1980a) Diagnosis of endogenous depression: comparison of clinical, research and neuroendocrine criteria. Journal of Affective Disorders, 2, 177–94.CrossRefGoogle ScholarPubMed
Carroll, B. J., Feinberg, M., Greden, J. F. et al (1981a) A specific laboratory test for the diagnosis of melancholia. Standardization, validation and clinical utility. Archives of General Psychiatry, 38, 15–22.CrossRefGoogle ScholarPubMed
Carroll, B. J., Feinberg, M., Steiner, M. et al (1980b) Diagnostic application of the dexamethasone suppression test in depressed outpatients. Advances in Biological Psychiatry, 5, 107–16.CrossRefGoogle Scholar
Carroll, B. J., Greden, J. F. & Feinberg, M. (1980c) Neuroendocrine disturbances and the diagnosis and aetiology of endogenous depression. Lancet, i, 321–2.Google Scholar
Carroll, B. J., Greden, J. F. & Feinberg, M. (1981b) Suicide, neuroendocrine dysfunction and CSF 5-HIAA concentrations in depression. In Recent Advances in Neuropsychopharmacology, Proceedings of 12th CINP Congress (ed. Angrist, B.). Oxford: Pergamon, pp 307–13.Google Scholar
Carroll, B. J., Greden, J. F. & Feinberg, M. et al (1980d) Neuroendocrine dysfunction in genetic subtypes of primary unipolar depression. Psychiatry Research, 2, 251–8.Google Scholar
Carroll, B. J., Greden, J. F. & Feinberg, M. et al (1981c) Evaluation of depression in borderline patients. Psychiatric Clinics of North America, 4, 89–99.Google Scholar
Carroll, B. J., Greden, J. F., Haskett, R. F. et al (1980e) Neurotransmitter studies of neuroendocrine pathology in depression. Acta Psychiatrica Scandinavica, 61, Suppl. 280, 183–200.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, 285–7.Google Scholar
Carroll, B. J. & Mendels, J. (1976) Neuroendocrine regulation in affective disorders. In Hormones, Behavior and Psychopathology (ed. Sachar, E. J.), pp 193–224. New York: Raven Press.Google Scholar
Carroll, B. J., Schroeder, K., Mukhopadhyay, S. et al (1980f) Plasma dexamethasone concentrations and Cortisol suppression response in patients with endogenous depression. Journal of Clinical Endocrinology and Metabolism, 51, 433–7.CrossRefGoogle ScholarPubMed
Court, J. (1968) Manic depressive psychosis: an alternative conceptual model. British Journal of Psychiatry, 114, 1523–30.CrossRefGoogle ScholarPubMed
Davis, J. M., Janowsky, D. & Casper, R. (1977) Acetylcholine and mental disease. In Neuroregulators and Psychiatric Disorders (eds. Usdin, E., Hamburg, D. A. and Barchas, J. D.), pp 434–41. Oxford University Press.Google Scholar
Davis, K., Berger, P. A., Hollister, L. E. et al (1978) Physostigmine in mania. Archives of General Psychiatry, 35, 119–22.CrossRefGoogle ScholarPubMed
Defrance, J. F., Stanley, J. C., Marchand, J. E. & Chronister, R. B. (1978) Cholinergic mechanisms and short-term potentiation. In Functions of the Septo-Hippocampal System, Ciba Foundation Symposium 58, (new series), pp 109–12. Amsterdam: Elsevier.Google Scholar
Dotti, A., Bersani, G. & Nocera, F. (1980) Dexamethasone suppression test as factor of differential diagnosis in endogenous depression. International Society of Psychoneuroendocrinology, XI International Congress, Florence, Italy, Abstracts, p 60.Google Scholar
Dysken, M. W., Pandey, G. N., Chang, S. S. et al (1979) Serial postdexamethasone Cortisol levels in a patient undergoing ECT. American Journal of Psychiatry, 136, 1328–9.Google Scholar
Feighner, J. P., Robins, E., Guze, S. B. et al (1972) Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry, 26, 57–63.Google Scholar
Feinstein, S. C. & Wolpert, E. A. (1973) Juvenile manic-depressive illness. Journal of the American Academy of Child Psychiatry, 12, 123–36.Google Scholar
Feldman, S. & Conforti, N. (1980) Participation of the dorsal hippocampus in the glucocorticoid feedback effect on adrenocortical activity. Neuroendocrinology, 30, 52–5.CrossRefGoogle ScholarPubMed
Galen, R. S. & Gambino, S. R. (1975) Beyond Normality: The Predictive Value and Efficiency of Medical Diagnoses. New York: Wiley.Google Scholar
Gershon, E. S., Mark, A., Cohen, N. et al (1975) Transmitted factors in the morbid risk of affective disorders: a controlled study. Journal of Psychiatric Research, 12, 283–99.Google Scholar
Gillespie, R. D. (1929) The clinical differentiation of types of depression. Guy's Hospital Reports, 79, 306–44.Google Scholar
Goldberg, I. K. (1980a) Dexamethasone suppression test as indicator of safe withdrawal of antidepressant therapy. Lancet, i, 376.CrossRefGoogle Scholar
Goldberg, I. K. (1980b) Dexamethasone suppression tests in depression and response to treatment. Lancet, ii, 92.Google Scholar
Goodman, L. A. (1965) On simultaneous confidence intervals for multinomial proportions. Technometrics, 7, 247–54.Google Scholar
Greden, J. F., Albala, A. A., Haskett, R. F. et al (1980a) Normalization of dexamethasone suppression tests: a probable index of recovery among endogenous depressives. Biological Psychiatry, 15, 449–58.Google Scholar
Greden, J. F. & Carroll, B. J. (1979) The dexamethasone suppression test as a diagnostic aid in catatonia. American Journal of Psychiatry, 136, 1199–200.Google Scholar
Greden, J. F., DeVigne, J. P., Albala, A. A. et al (1981) Post dexamethasone Cortisol levels among lithium-treated rapid cycling bipolar patients. In The Prediction of Lithium Response (ed. Dufour, H.). Paris: Economica Press.Google Scholar
Greden, J. F., Tarika, J., DeVigne, J. P. et al (1980b) Dexamethasone suppression test predicts treatment response. American Psychiatric Association Scientific Proceedings, New Research, Abstract 36.Google Scholar
Grossman, S. P. (1978) An experimental ‘dissection’ of the septal syndrome. In Functions of the Septo-Hippocampal System. Ciba Foundation Symposium 58 (new series), pp 227–60. Amsterdam: Elsevier.Google Scholar
Holsboer, F., Klein, H., Bender, W. et al (1980) Hypothalamic-pituitary-adrenal activity in a group of 100 heterogenic depressed patients: diagnostic validity and biochemical aspects of the Cortisol response to dexamethasone suppression. Progress in Neuro-Psycho-pharmacology, Suppl, Abstract 297, p 180.Google Scholar
James, N. McI. & Chapman, C. J. (1975) A genetic study of affective disorder. British Journal of Psychiatry, 126, 449–56.CrossRefGoogle ScholarPubMed
Jones, M. T., Hillhouse, E. & Burden, J. (1976) Secretion of corticotropin releasing hormone in vitro. In Frontiers in Neuroendocrinology, vol 4, (eds. Martini, L. and Ganong, W. F.), pp 195–226. New York: Raven Press.Google Scholar
Kiloh, L. G., Andrews, G., Nielson, M. et al (1972) The relationship of the syndromes called endogenous and neurotic depression. British Journal of Psychiatry, 121, 183–96.CrossRefGoogle ScholarPubMed
Klein, D. F. (1974) Endogenomorphic depression: a conceptual and terminological revision. Archives of General Psychiatry, 31, 447–54.Google Scholar
Kotin, J. & Goodwin, F. K. (1972) Depression during mania: clinical observations and theoretical implications. American Journal of Psychiatry, 129, 679–86.Google Scholar
Kraepelin, E. (1904) Lectures on Clinical Psychiatry. London: Baillière, Tindal and Cox.Google Scholar
Kuhn, R. (1963) Über kindliche Depressionen und ihre Behandlung. Schweizerische Medizinische Wochenschrift, 93, 86–90.Google Scholar
Kupfer, D. J. (1980) Personal communication. Google Scholar
Kupfer, D. J., Broudy, D., Spiker, D. G. et al (1979) EEG sleep and affective psychoses: I. Schizo-affective disorders. Psychiatry Research, 1, 173–8.CrossRefGoogle Scholar
Kupfer, D. J., Foster, F. G., Coble, P. et al (1978) The application of EEG sleep for the differential diagnosis of affective disorders. American Journal of Psychiatry, 135, 69–74.Google Scholar
Liddle, G. W. (1960) Tests of pituitary-adrenal suppressibility in the diagnosis of Cushing's Syndrome. Journal of Clinical Endocrinology and Metabolism, 20, 1539–60.Google Scholar
McCabe, M., Fowler, R., Cadoret, R. et al (1971) Familial differences in schizophrenia with good and poor prognosis. Psychological Medicine, 1, 326–32.CrossRefGoogle ScholarPubMed
McHardy-Young, S., Harris, P. W. R., Lessoff, M. H. et al (1967) Single-dose dexamethasone suppression test for Cushing's Syndrome. British Medical Journal, i, 740–4.Google Scholar
McLeod, W. R. (1972) Poor response to antidepressants and dexamethasone non-suppression. In Depressive Illness: Some Research Studies (eds. Davies, B., Carroll, B. J. and Mowbray, R. M.), pp 202–6. Springfield, Illinois: C. C. Thomas.Google Scholar
Nelson, J. C. & Charney, D. S. (1980) Primary affective disorder criteria and the endogenous-reactive distinction. Archives of General Psychiatry, 37, 787–93.CrossRefGoogle ScholarPubMed
Nugent, C. A., Nichols, T. & Tyler, F. H. (1965) Diagnosis of Cushing's Syndrome. Single dose dexamethasone suppression tests. Archives of Internal Medicine, 116, 172–6.CrossRefGoogle Scholar
Nuller, J. L. & Ostroumova, M. N. (1980) Resistance to inhibiting effect of dexamethasone in patients with endogenous depression. Acta Psychiatrica Scandinavica, 61, 169–77.CrossRefGoogle ScholarPubMed
Ossofsky, J. H. (1974) Endogenous depression in infancy and childhood. Comprehensive Psychiatry, 15, 19–25.Google Scholar
Papakostas, Y., Lee, J., Johnson, L. et al (1980) Neuroendocrine effects of ECT. Society of Biological Psychiatry Scientific Proceedings, Abstract 3, p 35.Google Scholar
Pavlatos, F. C., Smilo, R. P. & Forsham, P. H. (1965) A rapid screening test for Cushing's Syndrome. Journal of the American Medical Association, 193, 720–3.Google Scholar
Pope, H. G. Jr. & Lipinski, J. F. Jr. (1978) Diagnosis in schizophrenia and manic-depressive illness. Archives of General Psychiatry, 35, 811–28.CrossRefGoogle ScholarPubMed
Poznanski, E. O., Carroll, B. J. et al (1982) The dexamethasone suppression test in prepubertal depressed children. American Journal of Psychiatry. In press.Google Scholar
Puig-Antich, J. (1980) Affective disorder in childhood: a review and perspective. Psychiatric Clinics of North America, 3, 403–24.CrossRefGoogle Scholar
Puig-Antich, J., Chambers, W., Halpern, F. et al (1979) Cortisol hypersecretion in prepubertal depressive illness: a preliminary report. Psychoneuroendocrinology, 4, 191–7.Google Scholar
Puig-Antich, J., Tabrizi, M., Chambers, W. et al (1981) Prepubertal endogenous major depressives hyposecrete growth hormone in response to insulin induced hypoglycemia. Biological Psychiatry, 16, 801–18.Google Scholar
Roth, M. (1978) Psychiatric diagnosis in scientific and clinical settings. In Psychiatric Diagnosis: Exploration of Biological Predictors (eds. Akiskal, H. S. and Webb, W. L.), pp 9–47. Jamaica, New York: Spectrum Publications.Google Scholar
Rush, A. J., Giles, D., Parker, C. R. et al (1980) Sleep EEG findings and dexamethasone suppression in depression. Society of Biological Psychiatry Scientific Proceedings, Abstract 7, p 39.Google Scholar
Sachar, E. J., Hellman, L., Roffwarg, H. et al (1973) Disrupted 24 hour patterns of Cortisol secretion in psychotic depression. Archives of General Psychiatry, 28, 19–24.Google Scholar
Schlesser, M. A., Winokur, G. & Sherman, B. M. (1980a) Hypothalamic-pituitary-adrenal axis activity in depressive illness. Archives of General Psychiatry, 37, 737–43.CrossRefGoogle ScholarPubMed
Schlesser, M. A., Winokur, G. & Sherman, B. M. (1980b) Personal communication. Google Scholar
Seggie, J. A. & Brown, G. M. (1973) Effect of dexamethasone on affective behavior and adrenal reactivity following septal lesions in the rat. Journal of Comparative and Physiological Psychology, 83, 60–5.Google Scholar
Sitaram, N., Wyatt, R. J., Dawson, S. et al (1976) REM sleep induction by physostigmine infusion during sleep. Science, 191, 1281–3.Google Scholar
Stokes, P. E. (1966) Pituitary suppression in psychiatric patients. The Endocrine Society (USA), 48th Meeting Abstracts.Google Scholar
Stokes, P. E. (1972) Studies on the control of adrenocortical function in depression. In Recent Advances in the Psychobiology of the Depressive Illnesses (eds. Williams, T. A., Katz, M. M. and Shield, J. A.), pp 199–220. Washington, DC: US Government Printing Office.Google Scholar
Stone, M. (1979) Contemporary shift of the borderline concept from a subschizophrenic disorder to a sub-affective disorder. Psychiatric Clinics of North America, 2, 577–94.CrossRefGoogle Scholar
Taylor, M. A. & Abrams, R. (1980) Reassessing the bipolar-unipolar dichotomy. Journal of Affective Disorders, 2, 195–217.Google Scholar
Tourigny-Rivard, M. F., Raskind, M. & Rivard, D. (1981) The dexamethasone suppression test in an elderly population. Biological Psychiatry. (In press).Google Scholar
Wålinder, J. (1980) Personal communication. Google Scholar
Wetterberg, L. (1980) Personal communication. Google Scholar
Wilson, M. (1975) Effect of hippocampectomy on dexamethasone suppression of corticosteroid-sensitive stress responses. Anatomical Record, 181, 511.Google Scholar
Winokur, G. (1974) The use of genetic studies in clarifying clinical issues in schizophrenia. In Biological Mechanisms of Schizophrenia and Schizophrenia-Like Psychoses (eds. Mitsuda, H. and Fukuda, T.), pp 241–7. Tokyo: Igaku Shoin.Google Scholar
Winokur, G. & Cadoret, R. (1977) Genetic studies in depressive disorders. In Handbook of Studies on Depression (ed. Burrows, G.), pp 69–77. Amsterdam: Excerpta Medica.CrossRefGoogle Scholar
Winokur, G., Clayton, P. & Reich, T. (1969) Manic Depressive Illness, pp 112–21. St Louis: C. V. Mosby.Google Scholar
Woodruff, R. A., Goodwin, D. W. & Guze, S. B. (1974) Psychiatric Diagnosis. Oxford University Press.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.