Dexamethasone response, thyrotropin-releasing hormone stimulation, rapid eye movement latency, and subtypes of depression

• Published in: Biological psychiatry (1969) Vol. 41; no. 9; pp. 915 - 928
• Main Authors: Rush, A. John, Giles, Donna E., Schlesser, Michael A., Orsulak, Paul J., Weissenburger, Jan E., Fulton, Carl L., Fairchild, Carol J., Roffwarg, Howard P.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.1997; Elsevier Science
• Subjects: Adult; Adult and adolescent clinical studies; Biological and medical sciences; bipolar; Bipolar Disorder - classification; Bipolar Disorder - diagnosis; Bipolar Disorder - physiopathology; Depression; Depressive Disorder - classification; Depressive Disorder - diagnosis; Depressive Disorder - physiopathology; Dexamethasone; dexamethasone suppression test nonsuppression; Diagnosis, Differential; Female; Humans; Hydrocortisone - blood; laboratory tests; major depression; Male; Medical sciences; Middle Aged; Mood disorders; Polysomnography; Prognosis; Psychiatric Status Rating Scales; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Reaction Time - physiology; Reference Values; REM latency; Sleep, REM - physiology; Thyrotropin - blood; Thyrotropin-Releasing Hormone; thyrotropin-releasing hormone stimulation test blunting; unipolar; REM latency; bipolar; thyrotropin-releasing hormone stimulation test blunting; laboratory tests; unipolar; dexamethasone suppression test nonsuppression; major depression; Human; Dexamethasone test; Mood disorder; Laboratory study; Clinical form; Biological marker; Depression; TSH-RH-Test; Rapid eye movement sleep; Eye movement; Comparative study; Latency
• ISSN: 0006-3223; 1873-2402
• DOI: 10.1016/S0006-3223(97)00148-0

Most prior studies of mood disorders have used a single laboratory test to assist in differential diagnosis, prediction of treatment response, and prediction of relapse. This study compared three laboratory measures in a combined in- and outpatient sample of depressed patients. Dexamethasone suppression test (DST) nonsuppression occurred in 46% of patients with endogenous major depression, in 15% with nonendogenous major depression, and in 56% with bipolar, depressed phase disorder. A blunted thyrotropin-releasing hormone stimulation test (TRH-ST) occurred in 25% of patients with endogenous, 10% with nonendogenous, and 44% with bipolar, depressed phase disorder. Reduced REM latency was found in 65% of endogenous major depressions, in 34% of nonendogenous major depressions, and in 53% of bipolar, depressed phase disorders. Fifty-one percent of those with reduced REM latency also evidenced DST nonsuppression. When the endogenous major depression and bipolar, depressed phase groups were combined, 28% had no laboratory abnormality, whereas 8% evidenced all three. These findings suggest that 1) endogenous/nonendogenous unipolar groups are distinguished by all three laboratory tests; 2) most patients with a blunted TRH-ST also evidence DST nonsuppression; and 3) one half of patients with reduced REM latency evidence DST nonsuppression. Sensitivity is greatest and specificity is lowest for REM latency, followed by the DST and then the TRH-ST.