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II. Discrimination of Depressed From Nondepressed Patients

Bernard J. Carroll, MB, DPM, PhD; George C. Curtis, MD; Joseph Mendels, MD

Arch Gen Psychiatry. 1976;33(9):1051-1058.

Abstract
• Forty-two patients with endogenomorphic depression (ED) and 42 patients with other psychiatric disorders received an overnight dexamethasone test of hypothalamopituitary-adrenal (HPA) suppressibility. Plasma and urinary cortisol measures showed that the ED patients had significantly greater HPA activity before dexamethasone and less complete HPA suppression after dexamethasone. High cortisol values after dexamethasone correlated strongly with spontaneous HPA disinhibition, as indicated by high baseline midnight plasma cortisol levels. Criteria for defining normal suppression responses were developed. All patients with depressive neuroses and most patients with other nondepressive disorders had completely normal responses to dexamethasone. About half of the ED patients had abnormal responses, whether or not they were receiving other drugs at the time of the test. Drug-free patients with depressive neuroses or other disorders showed no abnormal responses to dexamethasone. The effects of psychotropic drugs on the test require further study. Patients with two or more abnormal cortisol values after administration of dexamethasone were identified correctly as ED at confidence levels close to100%. dexa-methasone suppression test may be of value as a laboratory aid in the diagnosis of "endogenous" depression.

Author Affiliations
From the Department of Psychiatry (Drs Carroll and Curtis), University of Michigan, Ann Arbor, and the Department of Psychiatry (Dr Mendels), University of Pennsylvania and Veterans Administration Hospital, Phila-delphia.

Footnotes
Accepted for publication April 7, 1976.

Reprint requests to Mental Health Research Institute, University of Michigan, Ann Arbor, MI 48109 (Dr Carroll).

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