Dexamethasone suppression test and depression in a rehabilitation setting

A diagnosis of depression is frequently considered in the evaluation of patients after cerebrovascular accident (CVA); however, the usual clinical signs of depression may be either masked in depressed patients or mimicked in nondepressed patients. The dexamethasone suppression test (DST), first used to screen patients with a suspected diagnosis of Cushing's disease, has been shown in the psychiatric population to be abnormal in about 50% of patients with primary or endogenous depression. This study employed the DST to assess its diagnostic value in a population of 20 CVA patients admitted to a rehabilitation hospital. The test was found to have an 83% specificity. Results suggest that the low incidence of primary depression in this setting greatly limits the utility of the DST in such usage.