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Article
September 1981

Dexamethasone Suppression Test and Diagnosis of Melancholia

Author Affiliations

Psychiatric Clinic Barnes and Renard Hospitals Washington University School of Medicine Medical School Box 8134 4940 Audubon Ave St Louis, MO 63110

Arch Gen Psychiatry. 1981;38(9):1067. doi:10.1001/archpsyc.1981.01780340119014
Abstract

To the Editor.—  Dr Carroll and his colleagues are doing an admirable job of studying the phenomenon of failure of dexamethasone to suppress serum cortisol secretion in depressed persons. In systematic fashion, they are establishing useful guidelines for the amount of dexamethasone to be administered, appropriate times for measuring serum cortisol following its administration, and cortisol secretion levels that will give optimum separation of "responders" and "nonresponders." I quite agree that their work (Archives 1981;38:15-22) gives "a basis for the standardization of this test in psychiatric settings" (p 20). However, I disagree with their claim that "The results of this study confirm the diagnostic value of the DST [dexamethasone suppression test] for melancholia..." (p 20). Melancholia, as well as all forms of affective disorder, is defined or diagnosed on a clinicaldescriptive basis. As pointed out by Scadding,1 "the process of diagnosis of a disease defined on a clinical-descriptive basis consists

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