Dexamethasone suppression test and onset of poststroke depression in patients with ischemic infarction.
BACKGROUND
Studies documenting abnormal results in the 1.0-mg dexamethasone suppression test (DST) and the prevalence of depression in stroke patients are usually accomplished between 1 and 6 months poststroke. One study, however, reported that 27% of patients met DSM-III criteria for major depression and 20% for minor depression 1 to 3 weeks poststroke even though previous research has indicated that the prevalence of poststroke depression was greatest at approximately 6 months. Therefore, we decided to assess DST abnormalities and depression within the first month of stroke.


METHODS
Twelve patients with single, computed tomography (CT)-verified, ischemic infarctions were administered the DST at 1 and 3 weeks poststroke. Each patient also received a complete psychiatric evaluation, including a special clinical interview and the 17-item Hamilton Rating Scale for Depression (HAM-D). 3 to 4 weeks poststroke.


RESULTS
DST results were abnormal in 75% of the patients at 1 week poststroke and 50% of the patients at 3 weeks poststroke. Those patients whose HAM-D scores revealed more depressive symptoms at 3 to 4 weeks were more likely to evidence abnormal DST results (cortisol nonsuppression). None of the patients, however, met either DSM-III or modified criteria for clinical depression at 3 to 4 weeks.


CONCLUSIONS
Poststroke depression appears to have a delayed clinical onset. Abnormal DST results at 3 weeks poststroke may serve as a potential marker for those patients at risk for developing poststroke depression.
Harney
J H
JH
Dallas Neurological Associates, Tex.
Fulton
C
C
Ross
E D
ED
Rush
A J
AJ
D000368:Aged; D015415:Biomarkers; D001921:Brain / Q000000981:diagnostic imaging; D002544:Cerebral Infarction / Q000150:complications* / Q000000981:diagnostic imaging; D002561:Cerebrovascular Disorders / Q000150:complications / Q000000981:diagnostic imaging; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D003907:Dexamethasone; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D015415:Biomarkers; D003907:Dexamethasone; D006854:Hydrocortisone