Table 1.
Dexamethasone suppression test studies with children and adolecents
| Study | MDD | Control | MDD measure | Dose | Collection method/time | Non-suppressors | Sensitivity (%) | Specificity (%) |
|---|---|---|---|---|---|---|---|---|
| Inpatient children | ||||||||
| Livingston et al. (1984) | 3 MDD (1 pure, 2 comorbid with DD, CD, etc.) | 12 PC | Dx assigned at clinical case conference | 0.5 mg @ 11 pm | Venipuncture @ 4 p.m. next day | 2/3 MDD 4/6 ANX 1/1 SZ-S 0/3 CD 0/2 MISC | 67 | 58 |
| Petty et al. (1985) | 7 MDD (3 pure, remainder comorbid with CD, aggressive behavior, etc.) | 23 PC | “Consensus dx” assigned using DSM-III criteria; KSADS-E administered for 60% across all groups | 0.5 mg @ 11 pm | Venipuncture @ 4 pm next day, 2/3 of all patients also had 11 pm venipuncture | 6/7 MDD 4/5 DD 5/6 SZ-S 1/3 CD 2/3 ANX 1/6 MISC | 86 | 43 |
| Casat et al. (1994) | 11 MDD (unknown comorbidity status) | 9 PC | Dx assigned by K-SADS-E using DSM-III-R criteria | 2 trials: 0.5 mg @ 11 pm on Days 1 and 6 | Venipuncture @ 8 am and 4 pm on Days 2 and 7 | Day 2: 3/11 MDD 5/9 PC Day 7: 2/11 MDD 3/9 PC | 27/18 | 44/66 |
| Pfeffer et al. (1989) | 20 MDD (unknown comorbidity status) | 31 PC | Dx assigned by 2 independent parent and child K-SADS-P, consensus dx made using DSM-III criteria | 0.5 mg @ 11 pm | Venipuncture @ 8 am, 4, and 11 pm next day | 11/20 MDD 4/31 PC | 55 | 87 |
| Pfeffer et al. (1989) | 19 MDD (unknown comorbidity status) | As above | As above | 1 mg @ 11 pm | As above | 2/19 MDD 1/31 PC | 11 | 97 |
| Fristad et al. (1988) | 63 MDD (unknown comorbidity status) | 14 PC 21 NC | DICA, CDI administered w/child and parents | 0.5 mg @ 11 pm | Venipuncture next day @ 8 am and 4 pm | Either time: 42/63 MDD 1/14 PC 2/21 NC | 67 | 91 |
| Naylor et al. (1990) | 14 MDD (unknown comorbidity status), 11 DD | 48 PC | “Consensus dx” assigned after 2 weeks of hospitalization based on DSM-III criteria | 0.5 mg @ 11 pm if < 36 kg 1 mg @ 11 pm if > 36 kg | Venipuncture @ 4 pm next day | 7/25 MDD + DD 11/48 PC | 28 | 77 |
| Doherty et al. (1986) | 59 MDD (19 pure, remainder comorbid) | 34 PC | Dx assigned by DSM-III criteria following “Standard clinical assessment” | 1 mg @ 11 pm | Venipuncture next day @ 8 am, 4 pm, and 11 pm | 15/34 MDD 4/19 DD 2/6 ADDM 1/15 ANX 0/4 CD 0/8 SZ-S 0/7 MISC | 44 | 88 |
| Weller et al. (1984) | 20 MDD (unknown comorbidity status) | N/A | Unknown | 0.5 mg @ 11 pm | Venipuncture next day @ 8 am and 4 pm | 14/20 MDD | 70 | N/A |
| Freeman et al. (1985) | 5 MDD (comorbid w/SZ-S) | N/A | Child, parent KSADS | 0.5 mg @ 11 pm | Venipuncture next day @ 4 pm | 4/5 MDD | 80 | N/A |
| Weller et al. (1985) | 50 MDD (unknown comorbiditystatus) | 18 PC 18 NC | DICA, DSM-III | 0.5 mg @ 11 pm | Venipuncture next day @ 8 am and 4 pm | 41/50 MDD 5/18 BD 2/18 NC | 82 | 72 PC 89 NC |
| Livingston and Martin-Cannici (1987) | 8 MDD (significant comorbid ANX) | 12 ANX 12 BD | Child, parent DICA | 0.5 mg @ 11 pm | Venipuncture next day @ 4 pm | 8/8 MDD 8/12 ANX 1/12 BD | 100 | 63 |
| Outpatient children | ||||||||
| Young et al. (2006) | 3 MDD; Due to low N only conducted analyses with grouped Dxs (3 MDD, 4 ANX, 3 ODD, 1 ADHD) | 32 NC | K-SADS | 2 trials, randomly assigned: 0.5 mg @ “bedtime” 1 mg @ “bedtime” | Saliva sample next day w/in 45 min of awakening, 4 pm, and “bedtime” | Not reported | Unknown | Unknown |
| Steingard et al. (1990) | 27 MDD (comorbidity status unknown), 29 MDD + ADHD | 5 PC | Clinical interviews conducted with child/parent, all dx based on DSM-III criteria | Weight corrected 17 µg/kg @ 11 pm | Venipuncture next day @ 4 pm | 8/27 MDD 11/29 MDD + ADHD 5/22 ADHD 0/5 PC | 34 | 81 |
| Birmaher et al. (1992a) | 26 MDD (comorbidity status unknown) | 10 PC 8 NC | 2 independent child and parent KSADS-P, MDD Dx assigned by RDC criteria, control dx by DSM-III | 0.25 mg @ 9 pm | Indwelling catheter: 24 hourly samples | 11/26 MDD 2/10 PC 6/8 NC | 42 | 55 overall 80 PC 25 NC |
| Birmaher et al. (1992a) | 23 MDD (comorbidity status unknown) | 13 PC 9 NC | As above | 0.5 mg @ 9 pm | As above | 4/23 MDD 0/15 PC 5/8 NC | 17 | 78 overall 100 PC 38 NC |
| Poznanski et al. (1982) | 9 MDD (comorbidity status unknown) | 9 PC | Dx assigned by “case conference consensus” after parent and child KSADS | 0.5 mg @ 11 pm | Venipuncture next day @ 4 pm | 5/9 MDD 1/9 PC | 56 | 89 |
| Geller et al. (1983) | 14 MDD (9 comorbid for antisocial behavior or ANX) | N/A | KSADS-P according to RCD and DSM-III | Weight corrected 20 µg/kg @ 11:30 pm | Venipuncture next day @ 4 pm | 2/14 MDD | 14 | N/A |
| Inpatient adolescents | ||||||||
| Extein et al. (1982) | 15 MDD (all “pure”) | 12 PC | Semistructured interviews, Dx assigned by DSM-III criteria for MDD | 1 mg @ 12 am | Venipuncture next day @ 8 am, noon, 4 pm, and midnight | 8/15 MDD 1/12 PC | 53 | 92 |
| Hsu et al. (1983) | 14 MDD (unknown comorbidity status) | 79 PC | Semistructured, standardized intake interview, chart review according to DSM-III criteria | 1 mg @ 11 pm | Venipuncture next day @ 4 pm and 11 pm | 9/14 MDD 2/6 ADDM 0/2 DD 4/26 CD 2/8 SZ-S 6/10 ED | 64 | 68 |
| Robbins et al. (1983) | 16 MDD (unknown comorbidity status) | 12 PC | “Consensus dx” according to RDC criteria based on K-SADS, Hamilton Rating Scale | 1 mg @ 11 pm | Venipuncture next day @ 8 am, 4 pm, 11 pm | 4/16 MDD 0/12 PC | 25 | 100 |
| Ha et al. (1984) | 26 (22 MDD, 4 w/”minor depressive d/o”) | 16 PC | Adolescent and parent KSADS | 1 mg @ 11:30 pm | Venipuncture next day @ 4 pm and 11 pm | 7/22 MDD 2/4 DD 3/16 PC | 32 | 75 |
| Targum and Capodanno (1983) | 17 MDD (unknown comorbidity status) | 103 PC | Dx assigned according to DSM-III criteria using clinical interview | 1 mg @ 11:30 pm | Venipuncture next day @ 4 pm @ 11:30 pm | 7/17 MDD 7/38 DD 7/47 CD 4/15 SZ-S | 41 | 82 |
| Robbins et al. (1982) | 4 MDD | 5 PC | 2 independent KSADS, consensus dx according to RCD criteria | 1 mg @ 11:30 pm | Venipuncture next day @ 8 am, 4 pm, 11 pm | 2/4 MDD 0/5 PC | 50 | 100 |
| Klee and Garfinkel (1984) | 20 MDD (unknown comorbidity status) | 13 PC | KSADS dx according to RDC criteria | 1 mg @ 11 pm | Venipuncture next day @ 8 am, 4 pm, 11 pm | 8/20 MDD 1/13 PC | 40 | 92 |
| Emslie et al. (1987) | 33 MDD (predominantly comorbid) | 18 DD 35 PC | Dx assigned according to DSM-III criteria using semistructured interview w/patients and parents | 0.5 mg for children (< Tanner 3), 1 mg for adolescents | Venipuncture next day @ 4 pm | 18/33 MDD 4/18 DD 4/35 PC | 55 | 89 (PC) |
| Woodside et al. (1987) | 10 MDD (unknown comorbidity status) | 18 CD 2 BP | Consensus diagnosis according to DSM-III | 1 mg @ 11 pm | Venipuncture next day @ 4 pm and 11 pm | 8/10 MDD 2/18 CD 2/2 BP | 80 | 80 |
| Khan (1987) | 33 MDD (predominantly comorbid) | 22 CD 6 DD 5 ADHD | Semistructured interview according to DSM-III | 1 mg @ 11 pm | Venipuncture next day @ 4 pm and 11 pm | 23/33 MDD 3/22 CD 1/6 DD 1/5 ADHD | 70 | 85 |
| Evans et al. (1987) | 20 MDD (unknown comorbidity) | 32 PC | Semi-/un-structured interview with patient and family members according to DSM-III criteria | 1 mg @ 11 pm | Venipuncture next day @ 4 pm and 11 pm | 8/20 MDD 5/32 PC | 40 | 84 |
| Appelboom-Fondu and Kerkhofs (1988) | 8 MDD (comorbid with bipolar) | 12 PC | KSADS according to RDC criteria | 1 mg @ 9 pm | Venipuncture next day @ 2 and 9 pm | 4/8 MDD 0/12 PC | 50 | 100 |
| Outpatient adolescents | ||||||||
| Birmaher et al. (1992b) | 44 MDD (Unknown comorbidity status) | 38 NC | 2 independent K-SADS administered, HAM-D, According to RDC criteria for MDD | 1.0 mg @ 11 pm | Indwelling catheter: hourly samples next day from 8 am - 11 pm | 6/44 MDD 1/38 NC | 14 | 97 |
| Dahl et al. (1992) | 27 MDD (significant comorbidity) | 34 NC | 2 independent parent and child KSADS-P, dx based on RDC, DSM-III criteria | 1 mg @ 11 pm | Indwelling catheter: hourly samples next day from 8 am - 11 pm | 4/27 MDD 3/34 NC | 15 | 91 |
ADDM adjustment disorder with depressed mood, ADHD attention-deficit/hyperactivity disorder, ANX anxiety disorders, BD behavior disorders (oppositional defiant disorder, ADHD with hyperactivity, conduct disorder), BP bipolar disorder, CD conduct disorder, DD dysthymic disorder, ED eating disorders, MDD major depressive disorder, MISC miscellaneous diagnoses, NC normative controls, ODD oppositional defiant disorder, PC psychiatric controls, SZ-S schizophrenia spectrum