The dexamethasone suppression test for diagnosing depression in stroke patients

Depression following a cerebrovascular accident is common, disabling, and treatable. However, the consequences of a stroke often render the clinical evaluation for depression misleading or difficult to interpret. These factors make a laboratory test for depression especially desirable in this population. We reviewed and evaluated the literature on the dexamethasone suppression test (DST) as a diagnostic tool for depression in stroke patients. Nine studies were identified. Our findings included (1) substantial variation in both methods and results, (2) a median specificity of 87%, and (3) a median sensitivity of 47%. We show that if these estimates of sensitivity and specificity are supported by future studies with improved methodology, then the DST may be clinically useful for the minority of stroke patients in whom a careful evaluation for depression remains inconclusive.