DEXAMETHASONE SUPPRESSION TEST AND ONSET OF POSTSTROKE DEPRESSION IN PATIENTS WITH ISCHEMIC INFARCTION

Background: Studies documenting abnormal results in the 1.0-mg dexamet hasone suppression test (DST) and the prevalence of depression in stro ke patients are usually accomplished between 1 and 6 months poststroke . One study, however, reported that 27% of patients met DSM-III criter ia for major depression and 20% for minor depression 1 to 3 weeks post stroke even though previous research has indicated that the prevalence of poststroke depression was greatest at approximately 6 months. Ther efore, we decided to assess DST abnormalities and depression within th e first month of stroke. Method. 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 th e 17-item Hamilton Rating Scale for Depression (HAM-D), 3 to 4 weeks p oststroke. Results: DST results were abnormal in 75% of the patients a t 1 week poststroke and 50% of the patients at 3 weeks poststroke. Tho se 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. Conclusion : Poststroke depression appears to have a delayed clinical onset. Abno rmal DST results at 3 weeks poststroke may serve as a potential marker for those patients at risk for developing poststroke depression.