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Dexamethasone Suppression Test and Diagnosis of Melancholia-Reply

Bernard J. Carroll, MD, PhD
Arch Gen Psychiatry. 1982;39(10):1219. doi:10.1001/archpsyc.1982.04290100075017.
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In Reply.  —Dr Schuman and his associates are concerned about how the primary care physician can effectively use the DST to evaluate the conditions of patients with depression. The guidelines they need were outlined in the original article: an abnormal test result will be strongly indicative of melancholia in a depressed patient, whereas a normal test result will not rule out this diagnosis when the clinical features are otherwise consistent.Whether the 50% sensitivity of the DST (in its simple outpatient version) is thought to be a limitation by the "beleaguered primary care physician" will depend on what that physician expects the test to do for him. If the DST can put him on the right track in treating an additional 25% of his patients with melancholia, then I consider it a useful contribution to the public health rather than an "absurdity" in a community-based practice.


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