title: The DEX/CRH test for major depression: a potentially useful diagnostic test.
abstract: The dexamethasone/corticotropin-releasing hormone (DEX/CRH) test has been proposed as a potential diagnostic test for major depressive disorder (MDD). A previously proposed four-step approach assesses the stage of development for a biological finding into a clinically useful diagnostic test. Using this approach, we evaluated the progress of the DEX/CRH test using meta-analysis as a part of step 1. A literature review identified 15 studies of the DEX/CRH test in patients with MDD and healthy controls. Meta-analysis estimated the effect size, heterogeneity, and confidence intervals using random effects models. Studies consistent with any step of the four-step approach were identified, and their characteristics were presented. Eleven studies reported significantly higher cortisol levels with the DEX/CRH test in patients with MDD, compared with the healthy controls (step 1). Eight eligible studies were included in meta-analysis, and had an effect size of 1.34 (95% confidence interval: 0.70-1.97). Most studies were step-1 studies (comparison of patients and healthy controls), and no step-4 studies (multicenter trials) were found. This review emphasizes that despite appearing as a promising test, the DEX/CRH has not been adequately studied for the required stages of development into a clinically useful laboratory test. Particularly, additional step-3 and step-4 studies are necessary.
authors.affiliation: Department of Psychiatry and Behavioral Neurosciences, Wayne State University, 2751 East Jefferson Avenue, Suite 437, Detroit, MI 48207, USA. mmokhtari@harthosp.org
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Mokhtari
authors.forename: Cynthia
authors.initials: C
authors.lastname: Arfken
authors.forename: Nash
authors.initials: N
authors.lastname: Boutros
mesh_terms: D003346:Corticotropin-Releasing Hormone; D003865:Major Depressive Disorder / Q000097:blood / Q000175:diagnosis*; D003907:Dexamethasone; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D010912:Pituitary-Adrenal Function Tests; D011237:Predictive Value of Tests
chemical_list: D003907:Dexamethasone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone