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Errors in Administration of the Dexamethasone Suppression Test-Reply

John F. Greden, MD; Steven C. Dilsaver, MD
Arch Gen Psychiatry. 1984;41(7):725-726. doi:10.1001/archpsyc.1984.01790180095020.
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In Reply.—  We concur with Dewan et al that withdrawal of certain medications may produce neuroendocrine changes, including the occasional nonsuppression in response to the DST. We caution that this finding is still quite tentative, however. In our report, when three of our 21 DST-nonsuppressive patients escaped only after tricyclic antidepressants were withdrawn, we hypothesized that this was due to a secondary cholinergic overdrive accompanying an anticholinergic withdrawal syndrome. If valid, this hypothesis should extend to any medication possessing anticholinergic properties. This would include the neuroleptic piperacetazine, used by Devanand et al1 to treat their patient. Thus, their observation is compatible with ours. In our research setting, we already have included recent antidepressant withdrawal as a potential exclusion criterion for DST results. Paradoxically, the "problem" of medication withdrawal might be more prevalent in research settings than in clinical programs, because research methods commonly emphasize drug washout periods.These observations also hint

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