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Dexamethasone Suppression Test and Diagnosis of Melancholia

George E. Murphy, MD
Arch Gen Psychiatry. 1981;38(9):1067. doi:10.1001/archpsyc.1981.01780340119014.
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To the Editor.—  Dr Carroll and his colleagues are doing an admirable job of studying the phenomenon of failure of dexamethasone to suppress serum cortisol secretion in depressed persons. In systematic fashion, they are establishing useful guidelines for the amount of dexamethasone to be administered, appropriate times for measuring serum cortisol following its administration, and cortisol secretion levels that will give optimum separation of "responders" and "nonresponders." I quite agree that their work (Archives 1981;38:15-22) gives "a basis for the standardization of this test in psychiatric settings" (p 20). However, I disagree with their claim that "The results of this study confirm the diagnostic value of the DST [dexamethasone suppression test] for melancholia..." (p 20). Melancholia, as well as all forms of affective disorder, is defined or diagnosed on a clinicaldescriptive basis. As pointed out by Scadding,1 "the process of diagnosis of a disease defined on a clinical-descriptive basis consists


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