Postdexamethasone Cortisol Levels and Subgroups of Affective Illness-Reply

In Reply.—  We thank Rothschild and Schatzberg for calling our attention to their earlier results showing a unipolar-bipolar difference in the plasma cortisol level after administration of dexamethasone.^1,2 The clinical significance of this finding is moot; other authors have not found the difference^3,4 and we found that much of the difference can be accounted for by confounding variables.⁵They point out that we found a higher incidence of nonsuppression in psychotic than in nonpsychotic unipolar depressed patients,⁶ and asked if psychosis might have influenced our more recent results.⁵ This is not likely, since only three of 107 unipolar and none of 69 bipolar patients were psychotic. This low incidence of psychosis may reflect our requiring valid, complete symptom ratings for patients included in this study.