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Am J Psychiatry 1993; 150:1618-1629
Copyright © 1993 by American Psychiatric Association
The DST as a predictor of outcome in depression: a meta-analysis
SC Ribeiro, R Tandon, L Grunhaus and JF Greden
Department of Psychiatry, University of Michigan, Ann Arbor.
OBJECTIVE: The authors undertook a review of the literature on the
dexamethasone suppression test (DST) as a predictor of course and outcome
in major depression, to illustrate clinical and pathophysiological
implications of studying the relation between biological measures and
course of illness in psychiatry. METHOD: In computerized searches and
cross-references, 144 articles were found that related DST results to
prediction of treatment response or outcome. Meta-analysis was performed on
pooled data from all of the studies and separately on data from selected
studies that had used stricter methodology. RESULTS: 1) Baseline DST status
did not predict response to antidepressant treatment or outcome after
hospital discharge. 2) Non-suppression of cortisol on the baseline DST
predicted poorer response to placebo. 3) Persistent nonsuppression of
cortisol on the DST after treatment was associated with high risk of early
relapse and poor outcome after discharge. CONCLUSIONS: Baseline DST results
may be devoid of prognostic value, but posttreatment nonsuppression of
cortisol on the DST is strongly associated with poor outcome. Persistent
nonsuppression may reflect a partially treated index episode or identify
sicker patients who are unresponsive to treatment. The findings reiterate
the importance of studying biological measures in relation to multiple
validators of psychiatric illness beyond cross- sectional diagnosis.
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