Cortisol and the Dexamethasone Suppression Test as a Biomarker for Melancholic Depression: A Narrative Review
- PMID: 37241007
- PMCID: PMC10223878
- DOI: 10.3390/jpm13050837
Cortisol and the Dexamethasone Suppression Test as a Biomarker for Melancholic Depression: A Narrative Review
Abstract
The dexamethasone suppression test (DST) assesses the functionality of the HPA axis and can be regarded as the first potential biomarker in psychiatry. In 1981, a group of researchers at the University of Michigan published a groundbreaking paper regarding its use for diagnosing melancholic depression, reporting a diagnostic sensitivity of 67% and a specificity of 95%. While this study generated much enthusiasm and high expectations in the field of biological psychiatry, subsequent studies produced equivocal results, leading to the test being rejected by the American Psychiatric Association. The scientific reasons leading to the rise and fall of the DST are assessed in this review, suggestions are provided as to how the original test can be improved, and its potential applications in clinical psychiatry are discussed. An improved, standardized, and validated version of the DST would be a biologically meaningful and useful biomarker in psychiatry, providing a tool for clinicians caring for depressed patients in the areas of diagnosis, treatment, and prognosis, and predicting the risk of suicide. Additionally, such a test could be a crucial part in the generation of biologically homogenous patient cohorts, necessary for the successful development of new psychotropic medications.
Keywords: Cushing’s syndrome; HPA-axis; cortisol; depression; dexamethasone suppression test; drug development; melancholia; suicide.
Conflict of interest statement
The authors declare no conflict of interest.
Similar articles
-
A comparison of the standard high dose dexamethasone suppression test and the overnight 8-mg dexamethasone suppression test for the differential diagnosis of adrenocorticotropin-dependent Cushing's syndrome.J Clin Endocrinol Metab. 1994 Feb;78(2):418-22. doi: 10.1210/jcem.78.2.8106630. J Clin Endocrinol Metab. 1994. PMID: 8106630 Clinical Trial.
-
Reevaluation of the combined dexamethasone suppression-corticotropin-releasing hormone test for differentiation of mild cushing's disease from pseudo-Cushing's syndrome.J Clin Endocrinol Metab. 2007 Nov;92(11):4290-3. doi: 10.1210/jc.2006-2829. Epub 2007 Jul 17. J Clin Endocrinol Metab. 2007. PMID: 17635947
-
A dose-response study of salivary cortisol after dexamethasone suppression test in Cushing's disease and its potential use in the differential diagnosis of Cushing's syndrome.Clin Endocrinol (Oxf). 2003 Dec;59(6):800-5. doi: 10.1046/j.1365-2265.2003.01908.x. Clin Endocrinol (Oxf). 2003. PMID: 14974925
-
The dexamethasone suppression test: an overview of its current status in psychiatry. The APA Task Force on Laboratory Tests in Psychiatry.Am J Psychiatry. 1987 Oct;144(10):1253-62. doi: 10.1176/ajp.144.10.1253. Am J Psychiatry. 1987. PMID: 3310667 Review.
-
The dexamethasone suppression test for diagnosis and prognosis in psychiatry. Commentary and review.Arch Gen Psychiatry. 1985 Dec;42(12):1193-204. doi: 10.1001/archpsyc.1985.01790350067012. Arch Gen Psychiatry. 1985. PMID: 3000317 Review.
Cited by
-
Translational interdisciplinary research on human chorionic gonadotropin's enhancement of neuroendocrine crosstalk: a novel medical hypothesis for systemic adjunctive treatment of psychiatric disorders.Front Psychiatry. 2025 Apr 29;16:1537442. doi: 10.3389/fpsyt.2025.1537442. eCollection 2025. Front Psychiatry. 2025. PMID: 40365004 Free PMC article.
-
Cortisol levels and depression suicide risk: a combined exploration of meta-analysis and case-control study.Front Psychiatry. 2025 Apr 30;16:1563819. doi: 10.3389/fpsyt.2025.1563819. eCollection 2025. Front Psychiatry. 2025. PMID: 40370593 Free PMC article.
-
Integrative analysis of miRNA expression profiles reveals distinct and common molecular mechanisms underlying broad diagnostic groups of severe mental disorders.Mol Psychiatry. 2025 Sep;30(9):4364-4383. doi: 10.1038/s41380-025-03018-9. Epub 2025 Apr 23. Mol Psychiatry. 2025. PMID: 40263528
-
Physical Activity and Depression in Breast Cancer Patients: Mechanisms and Therapeutic Potential.Curr Oncol. 2025 Jan 29;32(2):77. doi: 10.3390/curroncol32020077. Curr Oncol. 2025. PMID: 39996878 Free PMC article. Review.
-
Advancing Depression Management Through Biomarker Discovery with a Focus on Genetic and Epigenetic Aspects: A Comprehensive Study on Neurobiological, Neuroendocrine, Metabolic, and Inflammatory Pathways.Genes (Basel). 2025 Apr 25;16(5):487. doi: 10.3390/genes16050487. Genes (Basel). 2025. PMID: 40428308 Free PMC article. Review.
References
-
- Shorter E., Fink M. Endocrine Psychiatry: Solving the Riddle of Melancholia. Oxford University Press; Oxford, UK: 2010.
-
- Carroll B.J., Feinberg M., Greden J.F., Tarika J., Albala A.A., Haskett R.F., James N.M., Kronfol Z., Lohr N., Steiner M., et al. A specific laboratory test for the diagnosis of melancholia. Standardization, validation, and clinical utility. Arch. Gen. Psychiatry. 1981;38:15–22. doi: 10.1001/archpsyc.1981.01780260017001. - DOI - PubMed
Publication types
LinkOut - more resources
Full Text Sources