The dexamethasone suppression test in chronic alcoholics with and without depression and its relationship to their hepatic status

Abstract

Fifty consecutively admitted male alcoholics (mean age = 42.8 ± 8.5 years) were selected. This study shows objectively that 31 50 chronic alcoholics (62%) were found to be severely depressed (Hamilton Depression Rating Scale (HRS) > 22); 12 50 (24%) moderately depressed (HRS = 16–22); and 7 50 (14%) were not depressed (HRS < 15). According to dexamethasone suppression test (DST) results, 8 out of 50 patients showed escape from suppression with 2 mg dexamethasone while 42 50 showed normal suppression. Depression in alcoholics may be of neurotic type or it may be ethanol-induced reactive depression. Raised cortisol levels and abnormal DST response showed a definite tendency towards normalisation after total abstinence accompanied by clinical improvement of depressive symptomatology. The DST showed improvement on improvement of mood and sleep in these patients during total abstinence. An abnormal DST response in chronic alcoholics seems to be state-related and not trait-dependent; it seems to be a non-specific test for depression in alcoholics. Hepatic status was affected equally in both suppressors and non-suppressors of DST. It is therefore suggested that abnormal DST in alcoholics may be due to the abnormality of the hypothalamo-pituitary-adrenocortical (HPA) axis and not due to abnormal hepatic function or histological status.