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March 1984

Pretreatment DST and Hypothalamic-Pituitary-Adrenocortical Function in Depressed Patients and Comparison Groups: A Multicenter Study

Author Affiliations

From the Department of Psychiatry, Cornell University—New York Hospital Medical Center, New York (Dr Stokes and Mr Stoll); the Neuro-sciences Research Branch, National Institute of Mental Health, Rockville, Md (Dr Koslow); the Department of Psychiatry, University of Texas Health Science Center at San Antonio (Dr Maas); the Department of Psychiatry, Illinois State Psychiatric Institute, University of Illinois, Chicago (Dr Davis); the Department of Psychiatry and Behavioral Science, University of Texas Health Science Center at Houston (Dr Swann); and the Department of Psychiatry, Washington University School of Medicine, St Louis (Dr Robins).

Arch Gen Psychiatry. 1984;41(3):257-267. doi:10.1001/archpsyc.1984.01790140047006

• Pretreatment measures of hypothalmic-pituitary-adrenocortical (HYPAC) function in depressed, manic, and healthy normal subjects showed that nonsuppression on the dexamethasone suppression test (DST) had less positive predictive value for major diagnostic category and was more frequent in normals (8/77) than recently reported, although it was yet more frequent in depressed patients (35/111). Nonsuppression was common in manics (8/16), was similar in unipolar and bipolar depressed patients (35% and 27%, respectively), and did not segregate with melancholic, endogenous, or psychotic depression subtypes. Patterns of post-DST plasma cortisol concentration other than simple escape or nonescape from suppression were common. Nonsuppression of 9 am plasma cortisol levels on the DST had as good or better diagnostic specificity as nonsuppression of any of three post-DST samples. Nonsuppression was not completely synonymous with HYPAC hypersecretion. Means of pre-DST HYPAC measures (morning plasma cortisol, urine free cortisol, and CSF cortisol levels) were elevated in depressed patients compared with normals. There were significant differences in HYPAC measures of depressed patients studied at different centers. Age correlated positively and body weight negatively with plasma cortisol level.