Am J Psychiatry 1992; 149:1040-1045
Copyright © 1992 by American Psychiatric Association
The dexamethasone suppression test in adolescent outpatients with major depressive disorder
B Birmaher, RE Dahl, ND Ryan, H Rabinovich, P Ambrosini, M al-Shabbout, H Novacenko, B Nelson and J Puig-Antich
Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, PA 15213.
OBJECTIVE: The purpose of the study was to determine whether the
dexamethasone suppression test (DST) would discriminate between outpatient
adolescents with major depressive disorder and normal adolescent comparison
subjects. METHOD: Depressed patients were accepted into the study only if
they fulfilled the Research Diagnostic Criteria for major depressive
disorder. The depressed subjects (N = 44) and the normal subjects (N = 38)
were studied in the same environment and under the same conditions. The
subjects received 1 mg of dexamethasone at 11:00 p.m. The next day, blood
for determining plasma cortisol concentrations was drawn through an
indwelling catheter every 60 minutes from 8:00 a.m. until 11 p.m. RESULTS:
After dexamethasone, the cortisol levels of the adolescents with major
depressive disorder and the normal subjects were not significantly
different. Only six (14%) of the depressed subjects and one (3%) of the
normal subjects showed evidence of nonsuppression (cortisol value greater
than 5 micrograms/dl). Analyses of subgroups of the depressed patients
based on suicidal tendencies and endogenous subtype also failed to reveal
significant differences in cortisol values. Estimates of the severity of
depression showed significant negative correlations with cortisol values
among the depressed patients. CONCLUSIONS: In contrast with previous
studies of adolescent inpatients, the DST did not discriminate between the
adolescent outpatients with major depressive disorder and the normal
comparison subjects in this study. Possible reasons for the discrepancies,
such as severity of the depression and inpatient status, are discussed.
