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Dexamethasone Suppression Test as a Clinical Aid in Elderly Depressed Patients

Depression is a very common illness in elderly patients. Its manifestations may be similar to those in young depressed patients with mood disturbance; decreased sleep, appetite, and weight; inability to concentrate; and persistent fatigue. Other elderly depressed patients may present with less straightforward characteristics, such as chronic pain, multiple somatic complaints, or cognitive defects (pseudodementia). In young patients, it is becoming clear that within certain limits the dexamethasone suppression test (DST) is a very useful aid to diagnosing, treating, and following up depression. This paper will review clinical aspects of the DST and explore how it can be helpful in elderly patients who may be depressed. DST abnormalities imply hypothalamic imbalance, and depression itself presents clinically with several symptoms suggesting hypothalamic dysfunction. It has also been demonstrated that the same neurotransmitters that have been implicated in depression, particularly norepinephrine and serotonin, also regulate the secretion of hypothalamic neuroendocrine cells. 1