Cortisol Secretion and DST in Affective Disorders — Methodological Concerns

Abstract

In the wake of a large number of studies seeking biological markers for a variety of psychiatric disorders including affective disorders, the enthusiasm over Cortisol Secretion and Dexamethasone Suppression test lead the authors to review critically the data collected so far. The research designs involved, the samples studied and the reliability of the data collected along major variables such as diagnostic criteria, sampling characteristics, procedural differences, length of follow-up and the role of environmental stressors were evaluated. A useful exercise was to compare the literature published in the 50's and 60's with the more recent publications. The potential usefulness of DST as a diagnostic and management tool remains open for scrutiny. Whether the abnormalities in cortisol levels and DST responses evidenced by many researchers are an epiphenomenon or have a diagnostic and management value still remains unclear. From their analysis, the authors point out the lack of well controlled sequential studies using standardized procedures, and large age specific samples. Difficulty arising from the use of various terminologies and criteria for diagnosis of depressive disorders is recognized. The limitations of the use of DST in general clinical practice along with directions for future research are outlined.