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.
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In a meta-analysis of 15 studies examining the dexamethasone/CRH test as a potential biomarker for MDD, patients had greater cortisol levels following the test compared to controls.
“In a metaanalysis of 15 studies examing the role of the dexamethasone /CRH test as potential biomarker for MDD, patients had greater cortisol levels following the test compared to controls (171).”
From Childhood Trauma, the HPA Axis and Psychiatric Illnesses: A Targeted Literature Synthesis (2022) · cites this paper as [171]
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- Authors
- Mokhtari, M., Arfken, C., & Boutros, N.
- Affiliations
- Hartford Hospital (US)
- Wayne State University (US)
- Corresponding author
- Mokhtari, Mohammadreza
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2013-07
- Volume
- 208
- Issue
- 2
- Pages
- 131-139
- ISSN
- 0165-1781 (ISSN-L)
- OpenAlex
- W2121028619
- Cited by
- 79
- References
- 8
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 43 · 2022: 4 · 2021: 5 · 2020: 4 · 2019: 2 · 2018: 2 · 2017: 3 · 2016: 3 · 2015: 4 · 2014: 3 · 2013: 3
- FWCI
- 0.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- World Health Organization
- Department of Science and Technology, Ministry of Science and Technology, India
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- major depressive disorder, diagnostic test development, cortisol, dexamethasone, corticotropin-releasing factor, hypothalamic-pituitary-adrenal axis
- MeSH terms
- Corticotropin-Releasing Hormone, Major Depressive Disorder, Depressive Disorder, Major, Dexamethasone, Humans, Hydrocortisone, Pituitary-Adrenal Function Tests, Predictive Value of Tests
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