Amy A. F. Lutz: The Rise and Fall of the Dexamethasone Suppression Test: Stability, Consensus, Closure.

David Healy’s response to Amy Lutz’s reply to his comment and reply to Jay Amsterdam’s comment on his comment

        I think Jay Amsterdam missed the point about establishing a scientific fact. His note that the SSRIs came on the market 10 years later is wrong.  Several were marketed in the early 1980s, as noted below.

        Amy Lutz is being more wary about my comment than she needs to be. I certainly did not mean to disparage. Having spent a lot of my career doing oral interviews I accept the importance of these and spend more of my time supporting both the interviews with figures in the field and interviews with patients against the pseudo-science that gets reported in the clinical and non-clinical psychopharmacology literature.

        I would love to read the transcripts. Just as with clinical trials, the data is the people in the trials and in her article, it is the people being interviewed – reading the full interviews would be great.

        Let me reframe things.  Take the EKG QTc interval. This has had a huge impact on psychopharmacology. But we do not know what it means. We can’t measure it properly – it can’t be digitized for instance and used in an App. A lengthy QTc interval can be irrelevant – or not.  Some people drop dead, others don’t.  It can cause drugs to be removed from the market or not developed – but we essentially don’t know what on earth it is all about.

        However, it was established before we got operational and was not touched by DSM III, etc.  When DSM III was being formulated there was little or no reason to think the QTc interval was any more informative and relevant to clinical practice than the DST.

        By then, however, Lilly knew Prozac was of no use for melancholia. By the early ‘80s, the predecessors of SmithKline knew paroxetine was no good for melancholia and Pfizer knew Zoloft was of no use for melancholia.  The usefulness of the DST lies in the pointer it offers to melancholia – both the validity of the category and to the best treatment options – which did not include Zelmid, Indalpine and Faverin (Luvox), SSRIs marketed long before Prozac.

        My suggestion is that this was not a world in which the DST could survive.  Had things been different and had industry been bringing anti-melancholic agents to market, things might have been quite different. Tests don’t need to be accurate or understood to have a place in clinical practice and to shape that practice.

November 4, 2021