Dexamethasone suppression test and selection of antidepressant medications

John F. Greden, Ziad Kronfol, Robert Gardner, Michael Feinberg, Sunil Mukhopadhyay, A. Ariav Albala, Bernard J. Carroll

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Endogenous depressives with abnormal dexamethasone suppression tests (DSTs) respond better to somatic antidepressant treatments than those with normal DSTs. Whether the DST also aids in the selection of specific antidepressants has not been determined. A pilot report suggested that patients with abnormal DSTs might be noradrenaline-deficient and respond preferentially to imipramine or desipramine, whereas those with normal DSTs might be serotonin-deficient and respond best to amitriptyline or clomipramine. Attempting to replicate this observation, we studied 26 patients diagnosed with Research Diagnostic Criteria as major depressive disorder, endogenous subtype, and with DSM-III as having melancholia. All were drug-free during baseline evaluation. All had abnormal DST results, with post-dexamethasone plasma cortisol levels exceeding 5 μg/dl. We treated subjects with either imipramine or amitriptyline and compared clinical response with weekly Hamilton Depression Rating Scales, completed by raters blind to both DST results and the research question. Therapeutic plasma levels were documented. We found no significant differences in treatment response between the subgroups. Twenty of the 26 subjects did well. The imipramine-treated group failed to have either earlier response or better final outcome. These data fail to replicate suggestions that DST results assist in the selection of either imipramine or amitriptyline.

Original languageEnglish
Pages (from-to)389-396
Number of pages8
JournalJournal of Affective Disorders
Issue number4
Publication statusPublished - Dec 1981


ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

Greden, J. F., Kronfol, Z., Gardner, R., Feinberg, M., Mukhopadhyay, S., Albala, A. A., & Carroll, B. J. (1981). Dexamethasone suppression test and selection of antidepressant medications. Journal of Affective Disorders, 3(4), 389-396.