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Dexamethasone Suppression Test and Subtypes of Depression

Harvey Sternbach, MD; Harry Gwirtsman, MD; Robert H. Gerner, MD
Arch Gen Psychiatry. 1981;38(3):363. doi:10.1001/archpsyc.1981.01780280131016.
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To the Editor.—  In reference to the Schlesser et al article, "Hypothalamic-Pituitary-Adrenal Axis Activity in Depressive Illness: Its Relationship to Classification" (Archives 1980;37:737-743), the conclusions drawn by the authors do not appear to be valid based on the methodology used in their study. Carroll et al1 have shown that most patients with "endogenomorphic" depression did not show escape from dexamethasone suppression of cortisol until late afternoon (4 Pm) or evening (12 Am) on the day following dexamethasone administration. This point was also brought up by Brown and Shuey in their article, "Response to Dexamethasone and Subtype of Depression," which appeared in the same issue of the Archives (1980;37:747-751).The methodology used by Schlesser et al (ie, measuring only the 8 Am cortisol levels after dexamethasone administration) could have missed a substantial proportion of patients with familial pure depressive disease (FPDD), sporadic depressive disease (SDD), or depressive spectrum disease (DSD),

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