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Re: DST in major depression-SLS and ELizabeth

Posted by Cecilia on October 2, 2001, at 3:38:38

In reply to DST in major depression SLS, posted by Elizabeth on October 1, 2001, at 19:42:46

> > 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.
> -elizabeth

It sounds from what you`re saying that people with atypical depression are not too likely to respond to ketoconazole, is that correct? Also Cruz says he takes it only once every 2 weeks, wouldn`t it be long gone from your system before 2 weeks? My pdoc has never suggested a DST suppression test, (of course, I`m in a HMO), what is the main purpose of this test? I`ll ask my pdoc about this at my next appointment, but it`d be nice to have some more info, I dont have the impression that this is something most doctors would go for.




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