I’m posting this comment on behalf of Martin Schumacher (first author of the 2023 review article I linked above):
“I enjoyed reading this blog about the DST as a biomarker in psychiatry. Indeed, its usefulness as a diagnostic biomarker of melancholic depression (MD) is limited, as MD can be clinically diagnosed (e.g., by using the sign-based CORE criteria developed by Gordon Parker). But even in this situation, the DST could serve as a valuable test to substantiate/confirm the clinical diagnosis.
Other potential clinical uses of the DST are the assessment of the risk of suicide and the success of treatment (with ECT, TCAs or MAOIs). A response to treatment which is not accompanied by a normalization of the DST is likely to be followed by a relapse. The most important application of the DST is probably in drug development. Here, the DST will help to identify biologically homogenous patient groups.
As Aftab suggests, the DST should be applied in a transdiagnostic manner. The artificial borders between DSM-based diagnostic entities are very porous or even flatly wrong. The “manic-depressive insanity” diagnostic entity of Kraepelin (i.e., severe recurrent depression and/or mania, and psychosis) should be the main target of the DST.
I am not familiar with the literature about the DST and trauma and/or PTSD. However, this looks like another interesting field of application.
The outcome of the DST should not be interpreted in a strict binary fashion (i.e., suppression vs non-suppression), but as a continuous output. This continuum covers non-suppression (i.e., no suppression at all) all the way to a total suppression of cortisol secretion.
In this context, the fact that both Cushing's disease (hypercortisolism) and Addison's disease (hypocortisolism) are associated with depression and/or psychosis is noteworthy. Besides the DST, also the level and the shape of a cortisol diurnal profile might add useful information.
The DST assesses (only) the functionality of the HPA-axis. We should not forget that disturbances of all other endocrine axes are also related to psychiatric symptoms.
More information about these subjects can be found here:
I’m posting this comment on behalf of Martin Schumacher (first author of the 2023 review article I linked above):
“I enjoyed reading this blog about the DST as a biomarker in psychiatry. Indeed, its usefulness as a diagnostic biomarker of melancholic depression (MD) is limited, as MD can be clinically diagnosed (e.g., by using the sign-based CORE criteria developed by Gordon Parker). But even in this situation, the DST could serve as a valuable test to substantiate/confirm the clinical diagnosis.
Other potential clinical uses of the DST are the assessment of the risk of suicide and the success of treatment (with ECT, TCAs or MAOIs). A response to treatment which is not accompanied by a normalization of the DST is likely to be followed by a relapse. The most important application of the DST is probably in drug development. Here, the DST will help to identify biologically homogenous patient groups.
As Aftab suggests, the DST should be applied in a transdiagnostic manner. The artificial borders between DSM-based diagnostic entities are very porous or even flatly wrong. The “manic-depressive insanity” diagnostic entity of Kraepelin (i.e., severe recurrent depression and/or mania, and psychosis) should be the main target of the DST.
I am not familiar with the literature about the DST and trauma and/or PTSD. However, this looks like another interesting field of application.
The outcome of the DST should not be interpreted in a strict binary fashion (i.e., suppression vs non-suppression), but as a continuous output. This continuum covers non-suppression (i.e., no suppression at all) all the way to a total suppression of cortisol secretion.
In this context, the fact that both Cushing's disease (hypercortisolism) and Addison's disease (hypocortisolism) are associated with depression and/or psychosis is noteworthy. Besides the DST, also the level and the shape of a cortisol diurnal profile might add useful information.
The DST assesses (only) the functionality of the HPA-axis. We should not forget that disturbances of all other endocrine axes are also related to psychiatric symptoms.
More information about these subjects can be found here:
https://inhn.org/inhn-projects/controversies/default-title
“