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Dexamethasone suppression in depressed elderly outpatients.

R E Allen, F N Pitts

The Journal of Clinical Psychiatry

|September 1, 1984

Summary

The dexamethasone suppression test (DST) may be less common in older adults with major depressive disorder, showing no correlation with depression severity or treatment response. This suggests a potentially reduced relevance for specific treatment indications.

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Area of Science:

Geriatric Psychiatry
Neuroendocrinology
Mood Disorders

Background:

The dexamethasone suppression test (DST) is a diagnostic tool used in evaluating major depressive disorder (MDD).
Previous studies suggested a higher rate of positive DSTs in patients with melancholic depression.
The utility of DST in elderly, unipolar, treatment-naive MDD patients requires further investigation.

Purpose of the Study:

To assess the prevalence and significance of positive DST results in older adults (over 60) with unipolar major affective disorder.
To determine if DST positivity correlates with depression severity, melancholic features, or other clinical variables in this population.
To evaluate the relevance of DST findings for guiding specific treatment decisions in elderly MDD patients.

Main Methods:

A cohort of 85 previously untreated outpatients over age 60 with unipolar major depressive disorder were evaluated.
Patients underwent a systematic structured interview (NIMH-DIS) and scored over 20 on the Hamilton Depression Rating Scale (HAM-D).
The dexamethasone suppression test (DST) was administered, and serum cortisol levels were monitored following dexamethasone challenge.

Main Results:

Only 14% (12 of 85) of patients exhibited positive DST results.
A higher, though not statistically significant (p < .10), rate of positive DSTs was observed in non-melancholic (24%) compared to melancholic (10%) patients.
DST results did not correlate with HAM-D scores, Zung depression scores, gender, or treatment response.

Conclusions:

Positive DST results appear less common in older adults with major depressive disorder than previously reported.
DST positivity does not seem to be associated with greater depression severity or specific clinical features in this age group.
The findings suggest that the DST may have limited relevance for treatment indications in elderly patients with unipolar depression.

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