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DST in major depression SLS

Posted by Elizabeth on October 1, 2001, at 19:42:46

In reply to Re: ketoconazole/dexamethasone suppression test, posted by SLS on October 1, 2001, at 16:47:51

> I was under the impression that it was more than half. That is a good question.

It depends how narrowly you define major depression, that's my guess. (bearing in mind that even given the same diagnostic criteria, different clinicians may come to wildly different diagnoses of the same patient)

But this ought to be a pretty easy thing to find out....

Okay, the first report found that 40-50% of patients with "endogenous depression" (what we would call "major depression with melancholia" or something similar). Later studies seem to have confirmed this. The rate is similarly pretty high (higher, actually) in people with psychotic depression. But these results probably don't have much bearing on the general rate of DST-nonsuppression in people who are today considered to have major depression. In nonmelancholic depression the rate is more like 10-20%. In general, DST nonsuppression seems to correlate with severity (inpatients are more likely than outpatients to be nonsuppressors) and the presence of melancholic or psychotic features.

Lately there's been some interest in whether people respond differently to dexamethasone before and after successful treatment or remission. It appears that the DST response switches (i.e., that dexamethasone is able to suppress the HPA axis again) when remission is achieved.

That's a general overview. The DST has been studied in other disorders too, with variable and interesting results. Because of the recent surge in diagnosis of bipolar disorders (especially bipolar II), I'd prefer not to discuss the rate in bipolar depression, as the results of clinical trials that used more restrictive samples might be misleading.





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