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July 1984

Errors in Administration of the Dexamethasone Suppression Test

Author Affiliations

Department of Psychiatry Upstate Medical Center 750 E Adams St Syracuse, NY 13210; Department of Psychiatry Yale University School of Medicine 34 Park St New Haven, CT 06519; Department of Psychiatry Columbia University College of Physicians and Surgeons 722 W 168th St New York, NY 10032

Arch Gen Psychiatry. 1984;41(7):725. doi:10.1001/archpsyc.1984.01790180095019

To the Editor.—  Greden et al1 reported that some of their patients with suppressive responses to the dexamethasone suppression test (DST) became nonsuppressors after withdrawal from antidepressants, and they hypothesized a causal effect. We have recently reported2 the case of a non-depressed patient with a suppressive DST response in whom withdrawal from antipsychotics led to nonsuppression in response to the DST (a positive DST) on two separate occasions. The antipsychotic used was piperacetazine, which has marked anticholinergic properties.Both reports have suggested that anticholinergic withdrawal with subsequent cholinergic overdrive induces nonsuppression in response to the DST, as happens with the administration of physostigmine to normal subjects.3 Taken together, these data provide strong support for this being the mechanism of action. Carroll et al4 reported that neuroleptic treatment has no effect on the DST, but it is possible that withdrawal of neuroleptics with strong anticholinergic properties may give

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