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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Distinctions among affective disorders are reviewed in the light of dexamethasone non-suppression (DST) and shortened REM latency. Against the background of clinical, genetic and pharmacological information, such procedures may help to clarify biological continuities and discontinuities which need to be incorporated into the classification of affective disorders, and their differentiation from border conditions. Normal loss reactions, anxiety and dysphoric states are distinguishable from primary depression on the basis of REM latency. The melancholias, which tend in addition to be DST positive, are set apart from other primary depressions. Psychotic unipolar and bipolar depressions are classed under melancholia, because they tend to be most deviant in terms of cortisol non-suppression. Yet the fact that REM latency is abbreviated in most primary depressions, irrespective of the presence of melancholic features, argues for combining the two groups within a single class. These considerations suggest that the distinctions among affective subtypes are both categorical and dimensional.
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PMID:Diagnosis and classification of affective disorders: new insights from clinical and laboratory approaches. 637 97

The promise of an easily administered and highly specific test for depression has produced a rapidly growing literature, which now contains numerous exceptions to the specificity described earlier as well as misgivings about the test's performance when endogenous depression is rare. Due to its modest sensitivity and the effect of prevalence on positive predictive value, the DST is of little use as a screening test. These limitations, however, do not affect its use as a confirmatory test if the suspicion of 'endogenous' depression is strong. According to the large majority of studies, the DST is rarely abnormal in healthy controls or in schizophrenics. Some of the exceptions are probably due to the lack of appropriate exclusion criteria, recruitment bias, nonspecific assays for cortisol, the use of overly broad definitions of schizophrenia. The possibility remains that some schizophrenics, perhaps the ones in which negative symptoms predominate, are truly nonsuppressors. This is certainly true for patients with dementia and the DST now shows little promise as a diagnostic aid when that disorder is suspected. In light of family history, follow-up and sleep studies, the occurrence of abnormal DST results among patients with such diagnoses as schizophreniform disorder and borderline personality is more likely to indicate diagnostic heterogeneity than DST nonspecificity. Nonsuppression is specific to 'endogenous' depression in the large majority of reports despite considerable differences in the 4 most commonly studied definitions. The few studies which applied 2 or more definitions to the same sample found marked specificity for one and very little for another definition, however, and did not find them to be interchangeable. Despite the use of operational criteria, occult rater variance among investigators poses a serious problem for the study of affective disorder. Studies so far suggest that the DST can figure prominently in the solution.
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PMID:The use of laboratory tests in psychiatric diagnosis: the DST as an example. 639 22

Serum levels of 3,3',5' triidothyronine (reverse T3) were investigated in 32 patients with acute major depressive disorder. Twenty-six of these patients were also studied during a state of clinical improvement. Comparison subjects were 22 healthy controls, and 16 currently euthymic patients with histories of affective disorders (8 unipolar, 8 bipolar). The laboratory investigation included the determination of triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH), and thyroxin-binding globuline (TBG) levels in serum. The clinical symptoms were rated by the Comprehensive Psychopathological Rating Scale (CPRS) for depressive illness (CPRS global score), as well as the sum of 10 items (CPRS 10) and 22 items (CPRS 22) measuring depression. The patients were also divided into those having a normal or abnormal response to the dexamethasone suppression test; those having melancholia or not having melancholia; and those having primary or secondary depression. No significant difference in reverse T3 levels emerged among the patients with acute major depressive disorders, the euthymic unipolar or bipolar affective disorders, and the healthy controls. There were also no significant differences between those having an abnormal or normal DST test; those having primary or secondary depression; or those having melancholia or not having melancholia. In the group of patients with acute major depressive disorder, however, a significant increase in reverse T3 levels and a significant decrease in T3 levels, but no significant difference in T4 or TSH levels, were seen in the patients with the most pronounced clinical symptoms as measured by the CPRS. The implications of these findings are discussed.
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PMID:Reverse T3 levels in affective disorders. 641 4

Patients with DSM-III unipolar major depression (N = 26) were treated with tricyclic antidepressants after 2 weeks of inpatient drug-free observation and neuroendocrine testing. Medication was prescribed with individualized dosages and was monitored with blood levels. Treatment response (greater than or equal to 50% decrease in Hamilton depression score after 4 weeks) was seen in 6 of 13 patients given desipramine and 7 of 13 given nortriptyline. Of the 13 nonresponders, 9 accepted treatment with another drug and/or ECT; 5 responded. Thus, 18 of the 26 patients responded to treatment. Abnormal pretreatment DST was correlated with increased responsiveness to treatment, although all patients had a high probability of response.
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PMID:Neuroendocrine dysfunction and response to tricyclic antidepressants. 643 72

TSH response to I.V. TRH and suppression of cortisol secretion by dexamethasone were studied in 51 depressive inpatients. There was no significant relationship between the results on both tests, considering blunted TSH responses to TRH and nonsuppression on the DST. Both tests were not complementary in identifying various subgroups of depression as far as the predictive value of a positive result on either or both tests is concerned. Methodological and clinical issues regarding these markers are briefly discussed.
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PMID:The correlation of dexamethasone suppression test and thyrotropin-releasing hormone test results in different subtypes of depression. 643 95

In a study of 20 inpatients who met DSM-III criteria for schizophrenia, there was a high incidence of depressed mood (N = 14), DSM-III melancholia (N = 6) and dexamethasone nonsuppression (N = 7). This incidence of positive DSTs (serum cortisol greater than 5 micrograms/dl at 3:30 or 10:00) was significantly higher than the expected rate based on a literature review (35% vs. 4%, p less than .001). A positive DST did not result in all cases in antidepressant pharmacotherapy, nor did a negative result preclude such treatment. Hence, clinicians in the study did not "treat the DST" in the absence of clinical evidence of depression. This study is consistent with others reporting a significant proportion of depressed schizophrenics. However, some studies have claimed no differences in response to dexamethasone between nondepressed and schizophrenic patients. These findings do not support a biological basis for the RDC differentiation of primary and secondary depression and challenge the DSM-III concept of schizophrenia as excluding the diagnosis of major depression. Viewed from a different perspective, the data may support recent reports casting doubt on the specificity of the DST.
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PMID:The dexamethasone suppression test in schizophrenia. 646 27

The cortisol suppression index (CSI), a ratio of predexamethasone to postdexamethasone plasma cortisol levels, has been suggested as an alternate approach to the use of the DST in the diagnosis of depression. Forty-eight psychiatric inpatients were prospectively studied to compare the utility of the CSI to results obtained using Carroll's fixed values at 4 p.m. and 11 p.m. Eighty-eight percent (22/25) of depressed patients had an 8 a.m. CSI below 7.0; 73% (16/22) had a 4 p.m. CSI less than 2.5. This compared to a 76% detection rate using Carroll's criteria for nonsuppression. In this study the CSI provided a sensitive and specific interpretation of the dexamethasone suppression test in depression.
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PMID:Dynamics of the cortisol suppression index in depression. 648 May 69

A case is reported of a recurrent and treatment-resistant depression with a positive DST in an individual in whom adenocarcinoma of the pancreas was eventually diagnosed. Following excision of the tumor, there was increased therapeutic response to antidepressants and normalization of the DST.
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PMID:Treatment-resistant depression in an elderly patient with pancreatic carcinoma: case report. 648 May 71

Two patients with agoraphobic symptoms and major depressive disorder exhibited dexamethasone nonsuppression. Antidepressant pharmacotherapy was associated with remission of depressive symptoms and DST normalization. This improvement predated remission of agoraphobic symptoms by 1-2 months. It is suggested that agoraphobia was secondary to the depression in both cases.
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PMID:Secondary agoraphobia: two case reports. 649 May 95

In 70 inpatients with major depressive disorder postdexamethasone cortisol and prolactin, but not baseline cortisol and prolactin, was found to correlate significantly with various state variables of depression. Postdexamethasone prolactin appeared to be a more specific state variable of depression compared with postdexamethasone cortisol. While prolactin was decreased following dexamethasone in controls and nonendogenous depressed patients, in endogenous depressed patients prolactin was increased by 30%. Due to this inverse prolactin response to dexamethasone, the sensitivity of this test should be considerably increased by using a higher dexamethasone dosage. The DST failed to be a diagnostic marker for any subgroup of depression.
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PMID:Postdexamethasone prolactin and cortisol: a biological state variable in depression. 649 48


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