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

Pretreatment DST and Hypothalamic-Pituitary-Adrenocortical Function in Depressed Patients and... Abstract • 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. References 1. Maas JW, Koslow SK, Davis JM, Katz MM, Mendels J, Robins E, Stokes PE, Bowden CL: Biological component of the NIMH Clinical Research Branch Collaborative program on the psychobiology of depression: I. Background and theoretical considerations . Psychol Med 1980; 10:759-776.Crossref 2. Secunda S, Koslow SH, Redmond DE, Garver D, Ramsey A, Croughan J, Kocsis J, Hanin I, Lieberman K, Casper R: Biological component of the NIMH Clinical Research Collaborative Program on the psychobiology of depression: II. Methodology and data analysis . Psychol Med 1980;10:777-793.Crossref 3. Gibbons RD: Identifying biological subtypes in psychiatric research , in Gibbons RD, Dysken MW (eds): Statistical and Methodological Advances in Psychiatric Research . New York, Spectrum Books, 1983, pp 1-33. 4. Carroll BJ, Curtis GC, Mendels J: Neuroendocrine regulation in depression: I. Limbic system-adrenocortical dysfunction . Arch Gen Psychiatry 1976;33:1039-1044.Crossref 5. Stephens MA: Use of the Kolmogorov-Smirnov, Cramer-Von Mises and related statistics without extensive tables . J Am Stat Assoc 1974;69:730-737.Crossref 6. Shapiro SS, Wilk MB: An analysis of variance test for normality (complete samples) . Biometrika 1965;52:591-611.Crossref 7. Kramer CY: Extension of multiple range tests to group means with unequal numbers of replications . Biometrics 1956;12:307-310.Crossref 8. McHardy-Young S, Harris PWC, Lessoff MH, Lyne C: Single-dose dexamethasone suppression test for Cushing's syndrome . Br Med J 1967;1:740-744.Crossref 9. Carroll BJ, Feinberg M, Greden JF, Tarika J, Albala AA, Haskett RF, James NM, Kronfol Z, Lohr N, Steiner M, de Vigne JP, Young E: A specific laboratory test for the diagnosis of melancholia: Standardization, validation and clinical utility . Arch Gen Psychiatry 1981;38:15-22.Crossref 10. Stokes PE: Studies on the control of adrenocortical function in depression , in Williams TA, Katz MM, Shield JA (eds): Recent Advances in the Psychobiology of the Depressive Illnesses , publication (HSM) 70-9053. Dept of Health, Education, and Welfare, 1972, pp 199-220. 11. Brown WA, Daamen M, D'Agostino C, Dockery EL, Fournier PA, Parsells AH: Cortisol level response to 1- and 2-mg doses of dexamethasone . Am J Psychiatry 1983;140:609-611. 12. Amsterdam JD, Winokur A, Caroff SN, Conn J: The dexamethasone suppression test in outpatients with primary affective disorder and healthy control subjects . Am J Psychiatry 1982;139:287-291. 13. Stokes PE, Stoll PM, Koslow SH, Davis J, Swann AC: Pretreatment hypothalamic-pituitary-adrenocortical function in affective disease. Program and abstracts of the 13th Collegium Internationale Neuro-psychopharmacologium Congress, Jerusalem, June 1982, abstracts vol 2, p 698. 14. Schlesser MA, Winokur G, Sherman BM: Hypothalamic-pituitary-adrenal axis activity in depressive illness: Its relationship to classification . Arch Gen Psychiatry 1980;37:737-743.Crossref 15. Graham PM, Booth J, Gianfranco B, Galhenase S, Myers CM, Teoh CL, Cox LS: The dexamethasone suppression test in mania . J Affective Disord 1982;4:201-211.Crossref 16. Evans DL, Nemeroff CB: The dexamethasone suppression test in mixed bipolar disorder . Am J Psychiatry 1983;140:615-617. 17. Krishnan RR, Maltbie AA, Davidson JRT: Abnormal cortisol suppression in bipolar patients with simultaneous manic and depressed symptoms . Am J Psychiatry 1983;140:203-205. 18. Carroll BJ: Neuroendocrine function in mania , in Shopsin B (ed): Manic Illness . New York, Raven Press, 1979, pp 163-176. 19. Brown WA, Johnston R, Mayfield D: The 24-hour dexamethasone suppression test in a clinical setting: Relationship to diagnosis, symptoms and response to treatment . Am J Psychiatry 1979;136:543-547. 20. Sachar EJ, Kanter SS, Buie D, Engle R, Mehlman R: Psychoendocrinology of ego disintegration . Am J Psychiatry 1970;126:1067-1078. 21. Carroll BJ: The hypothalamic-pituitary-adrenal axis in depression , in Davies BM, Carroll BJ, Mowbray RM (eds): Depressive Illness: Some Research Studies . Springfield, Ill, Charles C Thomas Publisher, 1972, pp 23-208. 22. Stokes PE, Stoll PM, Mattson MR, Sollod RN: Diagnosis and psychopathology in psychiatric patients resistant to dexamethasone , in Sachar EJ (ed): Hormones, Behavior and Psychopathology . New York, Raven Press, 1976, pp 225-229. 23. Dewan MJ, Pandurangi AK, Boucher ML, Levy BF, Major LF: Abnormal dexamethasone suppression test results in chronic schizophrenic patients . Am J Psychiatry 1982;139:1501-1503. 24. Carroll BJ, Feinberg M, Greden JF, Haskett RF, James NM, Steiner M, Tarika J: Diagnosis of endogenous depression: Comparison of clinical, research and neuroendocrine criteria . J Affective Disord 1980;2:177-194.Crossref 25. Coryell W, Gaffney G, Burkhardt PE: DSM-III melancholia and the primary-secondary distinction: A comparison of concurrent validity by means of the dexamethasone suppression test . Am J Psychiatry 1982;139:120-122. 26. Feinberg M, Carroll BJ: Separation of subtypes of depression using discriminant analysis: I. Separation of unipolar endogenous depression from nonendogenous depression . Br J Psychiatry 1982;140:384-391.Crossref 27. Nelson JC, Charney DS, Vingiano AW: False positive diagnosis with primary affective disorder criteria . Lancet 1978;2:1252-1253.Crossref 28. Sachar EJ, Halbreich U, Asnis G, Nathan RS, Halpern FS: Neuroendocrine disturbance in depression , in Brambilla F, Racagni G, deWied D (eds): Progress in Psychoneuroendocrinology . New York, Elsevier North Holland Inc, 1980, pp 263-272. 29. Stokes PE, Pick GR, Stoll PM, Nunn WD: Pituitary-adrenal function in depressed patients: Resistance to dexamethasone suppression . J Psychiatr Res 1975;12:271-281.Crossref 30. Gibbons JL, McHugh PR: Plasma cortisol in depressive illness . J Psychiatr Res 1962;1:162-171.Crossref 31. Doig RJ, Mummery RV, Wills MR, Elkes A: Plasma cortisol levels in depression . Br J Psychiatry 1966;112:1263-1267.Crossref 32. Butler PWP, Besser GM: Pituitary-adrenal function in severe depressive illness . Lancet 1968;1:1234-1236.Crossref 33. Murphy BEP, Cosgrove JB, Mcllquham MC, Pattee CJ: Adrenal corticoid levels in human cerebrospinal fluid . Can Med Assoc J 1967;97:13-17. 34. Carroll BJ, Curtis GC, Mendels J: Cerebrospinal fluid and plasma free cortisol concentrations in depression . Psychol Med 1976;6:235-244.Crossref 35. Traskman L, Tybring G, Asberg M, Bertilsson L, Lantto B, Schalling D: Cortisol in the CSF of depressed and suicidal patients . Arch Gen Psychiatry 1980;37:761-767.Crossref 36. Marmor J: Systems thinking in psychiatry: Some theoretical and clinical interpretations . Am J Psychiatry 1983;140:833-838. 37. Asnis GM, Sachar EJ, Halbreich U, Nathan RS, Novacenko H, Ostrow LC: Cortisol secretion in relation to age in major depression . Psychosom Med 1981;43:235-242.Crossref 38. Brown WA, Shuey I: Response to dexamethasone and subtype of depression . Arch Gen Psychiatry 1980;37:747-751.Crossref 39. Robinson DS, Sourkes TL, Nies A: Monoamine metabolism in human brain . Arch Gen Psychiatry 1977;34:89-92.Crossref 40. Gerner RH, Gwirtsman HE: Abnormalities of dexamethasone suppression test and urinary MHPG in anorexia nervosa . Am J Psychiatry 1981;138:650-653. 41. Berger M, Doerr P, Lund R, Bronisch T, von Zerssen D: Neuroendocrinological and neurophysiological studies in major depressive disorder: Are there biological markers for the endogenous subtype? Biol Psychiatry 1982;17:1217-1242. 42. Walsh BT, Katz JL, Levin J, Kream J, Fukushima DK, Hellman LD, Weiner H, Zumoff B: Adrenal activity in anorexia nervosa . Psychosom Med 1978;40:499-506.Crossref 43. Berger M, Pirke KM, Doerr R, Krieg C, von Zerssen D: Influence of weight loss on the dexamethasone suppression test . Arch Gen Psychiatry 1983;40:585-586.Crossref 44. Strain GW, Zumoff B, Strain JJ, Levin J, Fukushima DK: Cortisol production in obesity . Metabolism 1980;29:980-985.Crossref 45. Redmond DE, Huang YH, Baulu J, Snyder DR, Maas JW: Norepinephrine and satiety in monkeys , in Vigersky RA (ed): Anorexia Nervosa . New York, Raven Press, 1977, pp 81-96. 46. Jones MT, Hillhouse E, Burden J: Secretion of corticotropin-releasing hormone in vitro , in Martini L, Ganong WF (eds): Frontiers in Neuroendocrinology . New York, Raven Press, 1976, vol 4, pp 195-226. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

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

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Publisher
American Medical Association
Copyright
Copyright © 1984 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1984.01790140047006
Publisher site
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Abstract

Abstract • 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. References 1. Maas JW, Koslow SK, Davis JM, Katz MM, Mendels J, Robins E, Stokes PE, Bowden CL: Biological component of the NIMH Clinical Research Branch Collaborative program on the psychobiology of depression: I. Background and theoretical considerations . Psychol Med 1980; 10:759-776.Crossref 2. Secunda S, Koslow SH, Redmond DE, Garver D, Ramsey A, Croughan J, Kocsis J, Hanin I, Lieberman K, Casper R: Biological component of the NIMH Clinical Research Collaborative Program on the psychobiology of depression: II. Methodology and data analysis . Psychol Med 1980;10:777-793.Crossref 3. Gibbons RD: Identifying biological subtypes in psychiatric research , in Gibbons RD, Dysken MW (eds): Statistical and Methodological Advances in Psychiatric Research . New York, Spectrum Books, 1983, pp 1-33. 4. Carroll BJ, Curtis GC, Mendels J: Neuroendocrine regulation in depression: I. Limbic system-adrenocortical dysfunction . Arch Gen Psychiatry 1976;33:1039-1044.Crossref 5. Stephens MA: Use of the Kolmogorov-Smirnov, Cramer-Von Mises and related statistics without extensive tables . J Am Stat Assoc 1974;69:730-737.Crossref 6. Shapiro SS, Wilk MB: An analysis of variance test for normality (complete samples) . Biometrika 1965;52:591-611.Crossref 7. Kramer CY: Extension of multiple range tests to group means with unequal numbers of replications . Biometrics 1956;12:307-310.Crossref 8. McHardy-Young S, Harris PWC, Lessoff MH, Lyne C: Single-dose dexamethasone suppression test for Cushing's syndrome . Br Med J 1967;1:740-744.Crossref 9. Carroll BJ, Feinberg M, Greden JF, Tarika J, Albala AA, Haskett RF, James NM, Kronfol Z, Lohr N, Steiner M, de Vigne JP, Young E: A specific laboratory test for the diagnosis of melancholia: Standardization, validation and clinical utility . Arch Gen Psychiatry 1981;38:15-22.Crossref 10. Stokes PE: Studies on the control of adrenocortical function in depression , in Williams TA, Katz MM, Shield JA (eds): Recent Advances in the Psychobiology of the Depressive Illnesses , publication (HSM) 70-9053. Dept of Health, Education, and Welfare, 1972, pp 199-220. 11. Brown WA, Daamen M, D'Agostino C, Dockery EL, Fournier PA, Parsells AH: Cortisol level response to 1- and 2-mg doses of dexamethasone . Am J Psychiatry 1983;140:609-611. 12. Amsterdam JD, Winokur A, Caroff SN, Conn J: The dexamethasone suppression test in outpatients with primary affective disorder and healthy control subjects . Am J Psychiatry 1982;139:287-291. 13. Stokes PE, Stoll PM, Koslow SH, Davis J, Swann AC: Pretreatment hypothalamic-pituitary-adrenocortical function in affective disease. Program and abstracts of the 13th Collegium Internationale Neuro-psychopharmacologium Congress, Jerusalem, June 1982, abstracts vol 2, p 698. 14. Schlesser MA, Winokur G, Sherman BM: Hypothalamic-pituitary-adrenal axis activity in depressive illness: Its relationship to classification . Arch Gen Psychiatry 1980;37:737-743.Crossref 15. Graham PM, Booth J, Gianfranco B, Galhenase S, Myers CM, Teoh CL, Cox LS: The dexamethasone suppression test in mania . J Affective Disord 1982;4:201-211.Crossref 16. Evans DL, Nemeroff CB: The dexamethasone suppression test in mixed bipolar disorder . Am J Psychiatry 1983;140:615-617. 17. Krishnan RR, Maltbie AA, Davidson JRT: Abnormal cortisol suppression in bipolar patients with simultaneous manic and depressed symptoms . Am J Psychiatry 1983;140:203-205. 18. Carroll BJ: Neuroendocrine function in mania , in Shopsin B (ed): Manic Illness . New York, Raven Press, 1979, pp 163-176. 19. Brown WA, Johnston R, Mayfield D: The 24-hour dexamethasone suppression test in a clinical setting: Relationship to diagnosis, symptoms and response to treatment . Am J Psychiatry 1979;136:543-547. 20. Sachar EJ, Kanter SS, Buie D, Engle R, Mehlman R: Psychoendocrinology of ego disintegration . Am J Psychiatry 1970;126:1067-1078. 21. Carroll BJ: The hypothalamic-pituitary-adrenal axis in depression , in Davies BM, Carroll BJ, Mowbray RM (eds): Depressive Illness: Some Research Studies . Springfield, Ill, Charles C Thomas Publisher, 1972, pp 23-208. 22. Stokes PE, Stoll PM, Mattson MR, Sollod RN: Diagnosis and psychopathology in psychiatric patients resistant to dexamethasone , in Sachar EJ (ed): Hormones, Behavior and Psychopathology . New York, Raven Press, 1976, pp 225-229. 23. Dewan MJ, Pandurangi AK, Boucher ML, Levy BF, Major LF: Abnormal dexamethasone suppression test results in chronic schizophrenic patients . Am J Psychiatry 1982;139:1501-1503. 24. Carroll BJ, Feinberg M, Greden JF, Haskett RF, James NM, Steiner M, Tarika J: Diagnosis of endogenous depression: Comparison of clinical, research and neuroendocrine criteria . J Affective Disord 1980;2:177-194.Crossref 25. Coryell W, Gaffney G, Burkhardt PE: DSM-III melancholia and the primary-secondary distinction: A comparison of concurrent validity by means of the dexamethasone suppression test . Am J Psychiatry 1982;139:120-122. 26. Feinberg M, Carroll BJ: Separation of subtypes of depression using discriminant analysis: I. Separation of unipolar endogenous depression from nonendogenous depression . Br J Psychiatry 1982;140:384-391.Crossref 27. Nelson JC, Charney DS, Vingiano AW: False positive diagnosis with primary affective disorder criteria . Lancet 1978;2:1252-1253.Crossref 28. Sachar EJ, Halbreich U, Asnis G, Nathan RS, Halpern FS: Neuroendocrine disturbance in depression , in Brambilla F, Racagni G, deWied D (eds): Progress in Psychoneuroendocrinology . New York, Elsevier North Holland Inc, 1980, pp 263-272. 29. Stokes PE, Pick GR, Stoll PM, Nunn WD: Pituitary-adrenal function in depressed patients: Resistance to dexamethasone suppression . J Psychiatr Res 1975;12:271-281.Crossref 30. Gibbons JL, McHugh PR: Plasma cortisol in depressive illness . J Psychiatr Res 1962;1:162-171.Crossref 31. Doig RJ, Mummery RV, Wills MR, Elkes A: Plasma cortisol levels in depression . Br J Psychiatry 1966;112:1263-1267.Crossref 32. Butler PWP, Besser GM: Pituitary-adrenal function in severe depressive illness . Lancet 1968;1:1234-1236.Crossref 33. Murphy BEP, Cosgrove JB, Mcllquham MC, Pattee CJ: Adrenal corticoid levels in human cerebrospinal fluid . Can Med Assoc J 1967;97:13-17. 34. Carroll BJ, Curtis GC, Mendels J: Cerebrospinal fluid and plasma free cortisol concentrations in depression . Psychol Med 1976;6:235-244.Crossref 35. Traskman L, Tybring G, Asberg M, Bertilsson L, Lantto B, Schalling D: Cortisol in the CSF of depressed and suicidal patients . Arch Gen Psychiatry 1980;37:761-767.Crossref 36. Marmor J: Systems thinking in psychiatry: Some theoretical and clinical interpretations . Am J Psychiatry 1983;140:833-838. 37. Asnis GM, Sachar EJ, Halbreich U, Nathan RS, Novacenko H, Ostrow LC: Cortisol secretion in relation to age in major depression . Psychosom Med 1981;43:235-242.Crossref 38. Brown WA, Shuey I: Response to dexamethasone and subtype of depression . Arch Gen Psychiatry 1980;37:747-751.Crossref 39. Robinson DS, Sourkes TL, Nies A: Monoamine metabolism in human brain . Arch Gen Psychiatry 1977;34:89-92.Crossref 40. Gerner RH, Gwirtsman HE: Abnormalities of dexamethasone suppression test and urinary MHPG in anorexia nervosa . Am J Psychiatry 1981;138:650-653. 41. Berger M, Doerr P, Lund R, Bronisch T, von Zerssen D: Neuroendocrinological and neurophysiological studies in major depressive disorder: Are there biological markers for the endogenous subtype? Biol Psychiatry 1982;17:1217-1242. 42. Walsh BT, Katz JL, Levin J, Kream J, Fukushima DK, Hellman LD, Weiner H, Zumoff B: Adrenal activity in anorexia nervosa . Psychosom Med 1978;40:499-506.Crossref 43. Berger M, Pirke KM, Doerr R, Krieg C, von Zerssen D: Influence of weight loss on the dexamethasone suppression test . Arch Gen Psychiatry 1983;40:585-586.Crossref 44. Strain GW, Zumoff B, Strain JJ, Levin J, Fukushima DK: Cortisol production in obesity . Metabolism 1980;29:980-985.Crossref 45. Redmond DE, Huang YH, Baulu J, Snyder DR, Maas JW: Norepinephrine and satiety in monkeys , in Vigersky RA (ed): Anorexia Nervosa . New York, Raven Press, 1977, pp 81-96. 46. Jones MT, Hillhouse E, Burden J: Secretion of corticotropin-releasing hormone in vitro , in Martini L, Ganong WF (eds): Frontiers in Neuroendocrinology . New York, Raven Press, 1976, vol 4, pp 195-226.

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Mar 1, 1984

References

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