[The dexamethasone test and the choice of treatment and drug in depression]

Abstract

A large body of literature data have indicated that the dexamethasone suppression test (DST) may be useful in diagnosing depression. It has been also hypothesized that depressed patients showing an abnormal response to dexamethasone administration ("DST-non suppressors") are responsive to the treatment with psychopharmacological agents whereas the "DST-suppressors" subjects are often "placebo-responders". Moreover, on the basis of considerations concerning the inhibitory role of noradrenaline in the control of both the activity of the hypothalamic-pituitary-adrenal axis and mood, it has been claimed that the "DST-non suppressors" subjects respond to the treatment with antidepressant drugs potentiating the noradrenergic activity at level of the central nervous system. The present review of the main data on the topic leads to conclude that the DST may be useful in selecting the most appropriate treatment for depressed patients; the test, however, does not make it possible to choose the antidepressant drug on the basis of its neurochemical profile.