This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

A Multicenter Study

Peter E. Stokes, MD; Peter M. Stoll; Stephen H. Koslow, PhD; James W. Maas, MD; John M. Davis, MD; Alan C. Swann, MD; Eli Robins, MD

Arch Gen Psychiatry. 1984;41(3):257-267.

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.

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).

Footnotes
Accepted for publication Aug 30, 1983.

Reprint requests to Department of Psychiatry, Cornell University—New York Hospital Medical Center, Payne Whitney Clinic, 525 E 68th St, New York, NY 10021 (Dr Stokes).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The Impact of Gender and Hypothalamic Pituitary Adrenal Activity on Depressive Symptoms Following Surgical Stress
Pinna et al.
J Health Psychol 2009;14:1095-1104.
ABSTRACT  

Association of angiotensin-converting enzyme gene promoter single nucleotide polymorphisms and haplotype with major depression in a northeastern Thai population
Angunsri et al.
Journal of Renin-Angiotensin-Aldosterone System 2009;10:179-184.
ABSTRACT  

Major Depressive Disorder and Hypothalamic-Pituitary-Adrenal Axis Activity: Results From a Large Cohort Study
Vreeburg et al.
Arch Gen Psychiatry 2009;66:617-626.
ABSTRACT | FULL TEXT  

The effect of exercise on adrenocortical responsiveness of patients with chronic low back pain, controlled for psychological strain
Chatzitheodorou et al.
Clin Rehabil 2008;22:319-328.
ABSTRACT  

Alterations in Stress Cortisol Reactivity in Depressed Preschoolers Relative to Psychiatric and No-Disorder Comparison Groups
Luby et al.
Arch Gen Psychiatry 2003;60:1248-1255.
ABSTRACT | FULL TEXT  

Cortisol, stress and depression * Authors' reply
Garland et al.
Br. J. Psychiatry 2002;181 :348-349.
FULL TEXT  

Bio-social origins of depression in the community: Interactions between social adversity, cortisol and serotonin neurotransmission
STRICKLAND et al.
Br. J. Psychiatry 2002;180:168-173.
ABSTRACT | FULL TEXT  

Post-Traumatic Stress Disorder
Yehuda
NEJM 2002;346:108-114.
FULL TEXT  

DST Studies in Psychotic Depression: A Meta-Analysis
Nelson and Davis
Am. J. Psychiatry 1997;154:1497-1503.
ABSTRACT | FULL TEXT  

Increased Evening Activation of the Hypothalamic-Pituitary-Adrenal Axis in Depressed Patients
Young et al.
Arch Gen Psychiatry 1994;51:701-707.
ABSTRACT  

Dissociation Between Pituitary and Adrenal Suppression to Dexamethasone in Depression
Young et al.
Arch Gen Psychiatry 1993;50:395-403.
ABSTRACT  

Combining and Comparing Area Estimates across Studies or Strata
McClish
Med Decis Making 1992;12:274-279.
ABSTRACT  

Serial Dexamethasone Suppression Tests and Plasma Dexamethasone Levels: Effects of Clinical Response to Electroconvulsive Therapy in Major Depression
Devanand et al.
Arch Gen Psychiatry 1991;48:525-533.
ABSTRACT  

Osteoporosis With Pathologic Hip Fractures in Major Depression
Van Vort et al.
J Geriatr Psychiatry Neurol 1990;3:10-12.
ABSTRACT  

Cortisol Secretion in Prepubertal Children With Major Depressive Disorder: Episode and Recovery
Puig-Antich et al.
Arch Gen Psychiatry 1989;46:801-809.
ABSTRACT  

Maximizing Diagnostic Information From the Dexamethasone Suppression Test: An Approach to Criterion Selection Using Receiver Operating Characteristic Analysis
Mossman and Somoza
Arch Gen Psychiatry 1989;46:653-660.
ABSTRACT  

Changes in Melatonin Levels but Not Cortisol Levels Are Associated With Depression in Patients With Eating Disorders
Kennedy et al.
Arch Gen Psychiatry 1989;46:73-78.
ABSTRACT  

The Evening Urine Cortisol Excretion Test in Depression
Zis et al.
Arch Gen Psychiatry 1987;44:919-920.
ABSTRACT  

Does the Dexamethasone Suppression Test Relate to Subtypes, Factors, Symptoms, or Severity?
Miller and Nelson
Arch Gen Psychiatry 1987;44:769-774.
ABSTRACT  

The Effects of Dexamethasone on Plasma Homovanillic Acid and 3-Methoxy-4-hydroxyphenylglycol: Evidence for Abnormal Corticosteroid-Catecholamine Interactions in Major Depression
Wolkowitz et al.
Arch Gen Psychiatry 1987;44:782-789.
ABSTRACT  

Dexamethasone Suppression Test and Plasma Dexamethasone Levels in Bulimia
Walsh et al.
Arch Gen Psychiatry 1987;44:797-800.
ABSTRACT  

Neuroendocrine Aspects of Primary Endogenous Depression: I. Cortisol Secretory Dynamics in Patients and Matched Controls
Rubin et al.
Arch Gen Psychiatry 1987;44:328-336.
ABSTRACT  

Enhanced Adrenal Sensitivity to Exogenous Cosyntropin (ACTH {alpha}1-24) Stimulation in Major Depression: Relationship to Dexamethasone Suppression Test Results
Jaeckle et al.
Arch Gen Psychiatry 1987;44:233-240.
ABSTRACT  

Electroencephalographic Sleep in Psychotic Depression: A Valid Subtype?
Thase et al.
Arch Gen Psychiatry 1986;43:886-893.
ABSTRACT  

Holzman's Fences: Chauvinism or Confusion?
Brown
Arch Gen Psychiatry 1986;43:910-912.
ABSTRACT  

The Validity of the Dexamethasone Suppression Test as a Marker for Endogenous Depression
Zimmerman et al.
Arch Gen Psychiatry 1986;43:347-355.
ABSTRACT  

{beta}-Endorphin/{beta}-Lipotropin Immunoreactivity in Endogenous Depression: Effect of Dexamethasone
Matthews et al.
Arch Gen Psychiatry 1986;43:374-381.
ABSTRACT  

The Validity of Four Definitions of Endogenous Depression: II. Clinical, Demographic, Familial, and Psychosocial Correlates
Zimmerman et al.
Arch Gen Psychiatry 1986;43:234-244.
ABSTRACT  

The Dexamethasone Suppression Test for Diagnosis and Prognosis in Psychiatry: Commentary and Review
Arana et al.
Arch Gen Psychiatry 1985;42:1193-1204.
ABSTRACT  

Cortisol Secretion in Endogenous Depression: I. Basal Plasma Levels
Halbreich et al.
Arch Gen Psychiatry 1985;42:904-908.
ABSTRACT  

Cortisol Secretion in Endogenous Depression: II. Time-Related Functions
Halbreich et al.
Arch Gen Psychiatry 1985;42:909-914.
ABSTRACT  

The Dexamethasone Suppression Test and Pituitary-Adrenocortical Function
Brown et al.
Arch Gen Psychiatry 1985;42:121-123.
ABSTRACT  

Limited Utility of the 1-mg Dexamethasone Suppression Test as a Measure of Hypercortisolism
Zimmerman and Coryell
Arch Gen Psychiatry 1985;42:200-201.
ABSTRACT  

Limited Utility of the 1-mg Dexamethasone Suppression Test as a Measure of Hypercortisolism
Berger et al.
Arch Gen Psychiatry 1985;42:201-202.
ABSTRACT  

Limited Utility of the 1-mg Dexamethasone Suppression Test as a Measure of Hypercortisolism-Reply
Stokes et al.
Arch Gen Psychiatry 1985;42:202-204.
ABSTRACT