Dexamethasone Suppression Test – a tool for decision making in antidepressive treatment?

The Dexamethason-Suppression-Test (DST) was initially suggested as a diagnostic tool in clinical practice to validate MDE diagnoses by an objective laboratory parameter. At least in the last ten years the DST is more a tool in basic and clinical research may be do to a lack of sensitivity as well as specifity of the DST to detect MDE or to diffentiate between psychiatric disorders, the DST disappeared more and more from clinical practice. The aim of the present study was, to investigate if there is any reason left to conduct the DST in everyday clinical practice. In a retrospective study of 161 inpatients suffering from a major depressive episode we looked if DST-suppression status, individual antidepressive treatment and response rates are connected to therapy outcome with respect to different psychopharmacological treatment regimes. The Odds ratio for NaSSA response rates (OR=4.5) indicate, that DST-Nonsuppressors compared to DST-Suppressors showed a 4.5-fold heightened chance, to respond to a NaSSA treatment than to another pharmacological treatment. Otherwise, seem DST-Nonsuppressors compared to DST-Suppressors to have a lowered response rate to a medication with SNRI (OR=0.4) or SSRI (OR=0.7) DST-Nonsuppressors showed a higher likelihood to respond to NaSSA compared to SSRI or SNRI, while suppressors seem to have a higher benefit from the letter treatment. So the DST should be regarded as a possible tool for decision making in antidepressant treatment.