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DST studies in psychotic depression: a meta-analysis
1Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
The American Journal of Psychiatry
|November 14, 1997
Summary
Psychotic depression is strongly linked to cortisol nonsuppression, with 64% of patients showing this trait compared to 41% of nonpsychotic individuals. This finding highlights hypercortisolemia
Area of Science:
- Neuroscience
- Psychiatry
- Endocrinology
Background:
- Hypersecretion of cortisol is frequently observed in psychotic depression, but existing studies show mixed results.
- Cortisol nonsuppression on the dexamethasone suppression test (DST) is a potential biomarker, yet its association with psychotic depression requires clarification.
Purpose of the Study:
- To conduct a meta-analysis of existing studies to determine the significance of cortisol nonsuppression in psychotic depression.
- To compare cortisol nonsuppression rates across different subtypes of major depression.
Main Methods:
- A Mantel-Haenszel meta-analysis was performed on 14 studies comparing DST results in psychotic versus nonpsychotic patients.
- Nineteen additional studies were reviewed to compare DST results related to melancholic/nonmelancholic and inpatient/outpatient distinctions.
Main Results:
- A highly significant association was found between psychotic depression and cortisol nonsuppression (64% nonsuppression rate).
- Nonpsychotic patients showed a 41% nonsuppression rate.
- Cortisol nonsuppression was less frequent in melancholic depression (36%) and not significantly associated when controlling for inpatient/outpatient status. Nonmelancholic outpatients had a low nonsuppression rate (12%).
Conclusions:
- Psychotic depression is the subtype of major depression most strongly associated with cortisol nonsuppression on the DST.
- The presence of hypercortisolemia in psychotic depression may be crucial for understanding its pathophysiology.