Posted by vince on June 10, 2001, at 1:03:00
I thought some might be interested in the following article.
I have a question in the event one of our very knowledgeble babble members reads this post. Does one have to be completely off medication in order to get a correct response to the dexamethasone suppression test?
Just a point of interest to me, in several posts here I've described what drives my suicidal desire as a psycological pain that doesn't relate to sadness, despair, guilt, feelings of worthlessness, or many of the symptoms that are usually attributed to major depression, though I do suffer many of these other symptoms to some extent these are not what drives my suicidal desires. What drives the desire for suicide in me is a terrible mental pain, which I can't seem to find a name for, but which I am driven to want to extinguish.
After reading the article to follow, I wonder how other people who feel driven toward suicide would describe the feeling that drives their suicidal ideation and if there would be a similarity amoung those who test positive for HPA axis hyperactivity. If I were a researcher instead of a lab rat I would like to find out if there is a similarity in what drives suicide in those patients as apposed to other types of suicidal depression. Not sure what it would accomplish but it would be interesting none the less.
Vince
Suicide Risk Linked to Hypothalamic-Pituitary-Adrenal Axis Hyperactivity
--------------------------------------------------------------------------------WESTPORT, CT (Reuters Health) Jun 04 - Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis appears to be characteristic of patients with major depressive disorder who commit suicide, according to 15-year follow-up of patients who entered the National Institute of Mental Health Collaborative Study of the Affective Disorders.
Dr. William Coryell, of the University of Iowa College of Medicine, in Iowa City, and Dr. Michael Schlesser, of Dallas Neuropsychiatry Associates, identified 78 subjects who underwent the dexamethasone suppression test while hospitalized for major depression or schizoaffective disorder.
The subjects swallowed 1 mg of dexamethasone at 11:00 PM and provided one or two blood samples for cortisol level measurement the next day. Thirty-two patients exhibited post-dexamethasone cortisol levels >5 µg/dL and thus were considered nonsuppressors.
Based on information on death certificates, the investigators identified eight subjects who subsequently committed suicide, as they report in the May issue of the American Journal of Psychiatry. Seven were cortisol nonsuppressors. Thus, HPA-axis hyperactivity increased the odds of completed suicide 14-fold.
"The disparity between suppressors and nonsuppressors in the likelihood of suicide increased throughout the 15 years of follow-up," the investigators write, indicating that "the suicide risk implied by a positive dexamethasone result is an enduring one." In contrast, male sex, living alone, suicide attempt during the index illness, and presence of hopelessness in the week preceding intake did not predict suicide.
Along with postmortem evidence and data from three other nonoverlapping studies, these results support the view that nonsuppression of cortisol is associated with suicide in patients with major depressive disorder, Drs. Coryell and Schlesser conclude.
"If this were replicated and we knew more about just what subgroups this applies to, this test would be useful in helping to assess an individual's risk for suicide," Dr. Coryell told Reuters Health.
At present, the test is "not ready for wide use," he noted, explaining, "We don't know whether there are groups of depressed individuals for whom the results of this test would not have this kind of predictive significance. That ought to be worked out before clinicians start to use this routinely."
Am J Psychiatry 2001;158:748-753.
poster:vince
thread:65990
URL: http://www.dr-bob.org/babble/20010605/msgs/65990.html