Classics in ECT: Serial DSTs in a Patient Getting ECT, American Journal of Psychiatry, 1979

 "Classics in ECT" brings you this Clinical and Research Report from the American Journal of Psychiatry, from 1979:

Serial postdexamethasone cortisol levels in a patient undergoing ECT.

Dysken MW, Pandey GN, Chang SS, Hicks R, Davis JM.Am J Psychiatry. 1979 Oct;136(10):1328-9. doi: 10.1176/ajp.136.10.1328.PMID: 484732


The pdf is here.

The article is here:


Ah, the good old days, when it looked like the dexamethasone suppression test (DST) was going to succeed as our biological test for depression and successful treatment.
Here's a nice classic case report with careful serial DSTs and mood ratings. Alas, the DST was not quite good enough, and the political headwinds against it were strong enough, that it got canceled. But dysregulation of the HPA axis remains one of the most replicated endocrinological abnormalities in severe depression to this day. The catecholamine-o-centric note at the end is not unexpected, given that John Davis is the senior author of this report.


Comments

  1. ECTbloggerJanuary 8, 2023 at 1:20 PM

    The below comment is from Dr. Max Fink:

    The DST relationship to clinical outcome and seizures was established by Bernard Carroll in 1975. The rejection of the DST by the APA Committee headed by Dr. Glassman in 1986 was a political act, supporting the DSM-III. It was not a scientific act. The concept of melancholia as an identifiable. verifiable and treatable form of mood disorder was established by Bernard Carroll and his students, by Gordon Parker in 1990s and by Taylor and Fink in 2006. The rejection of the DST as a valuable biological marker of melancholia and the effects of inducing seizures is a tragedy.

    Max Fink

    ReplyDelete

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