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Annals of General Psychiatry

, 7:22

First Online: 13 November 2008Received: 13 October 2008Accepted: 13 November 2008


BackgroundImportant methodological questions still exist concerning the Dexamethasone Suppression Test DST, including the possibility of a better way of interpreting it. The aim of the present study was to explore the feasibility of an alternative way of interpreting DST results.

MethodsA total of 50 patients with major depression aged 41.0 ± 11.4 years old participated in the study. Past and present suicide attempts were recorded. Psychometric assessment included the Hamilton Depression Rating Scale HDRS, the Hamilton Anxiety Scale HAS, the Newcastle Depression Diagnostic Scale NDDS, the Diagnostic Melancholia Scale DMS and the General Assessment of Functioning GAF scale. The 1 mg DST protocol was used. Analysis methods included the chi square test and analysis of covariance ANCOVA with Fisher least significant difference LSD as post hoc tests.

ResultsIn all, 34 patients 68% were suppressors, 16 32% were non-suppressors and 14 patients had cortisol values above 5 μg-dl at baseline. Baseline cortisol level did not influence the classical DST interpretation. A total of 18 patients 36% showed an increase of their cortisol levels after dexamethasone administration and 32 patients 64% showed a decrease. Reducers had less melancholic features, similar levels of depression, better sleep and less suicidal thoughts in comparison to increasers. No relationship of DST to suicidality was found.

DiscussionThe present study explored the pattern of cortisol response to dexamethasone suppression and suggested an alternative way of coding and interpreting the DST on the basis of whether the cortisol levels remain stable or increase vs decrease after the administration of cortisol. The results put forward a complex way of understanding the relationship of the DST results with clinical symptoms.

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Autor: Konstantinos N Fountoulakis - Xenia Gonda - Zoltan Rihmer - Costas Fokas - Apostolos Iacovides


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