Accuracy of Dexamethasone Suppression Test in Alcoholics

Abstract

To the Editor.— Swartz and Dunner reported a 33% incidence of DST abnormalities in alcoholics who did not meet clinical criteria for the diagnosis of major depressive illness. The authors concluded that such a high incidence of false positives renders the DST insufficiently specific for diagnosis of major depression in alcoholics. Before this conclusion becomes widely accepted and further study of this important clinical issue is preempted, we would like to discuss the implications of our recent DST data in alcoholics. Our data are consistent with the results obtained by Swartz and Dunner but not consistent with their conclusions. We recently reported DST data on hospitalized alcoholics tested within five days of their last drink, and again after three weeks of sobriety. 1 Major depression was ruled out with a Schedule for Affective Disorders and Schizophrenia-Change interview and all patients had normal bilirubin and hepatic enzyme values. Like Swartz and Dunner, we