Sleep Disorders Center, Baptist Memorial Hospital and "Department of Psychiatry, University of Tennessee, Memphis, Tennessee, 38163
Patients with fear or depression of long standing are subject to melancholia. Hippocrates, Aphorisms V (10) A woman at Thasos became morose as the result of a justifiable grief, and . . . she suffered from insomnia, loss of appetite . . . she complained of fears and talked much; she showed despondency and . . . many intense and continuous pains. Hippocrates, Epidemics HI (10)
It has been known since the time of Hippocrates that depression is a frequent complication of anxiety disorders and that anxiety symptoms are common man­ifestations of depressive illness. Research in our clinic (16) has shown that patients with concomitant anxiety and depressive manifestations tend to be the most severe, chronic, and disabling variants of affective illness. Determining which is the primary disorder on strictly clinical grounds often proves difficult in cross-sectional examination. However, certain clinical clusters are characteristic of each disorder (12). These include traditional clinical markers, such as early morning awakening, self-denigration, psychomotor retardation, hopelessness, and suicidal tendencies in depressive disorders, and somatic tension, panic at­tacks, and compulsions in anxiety disorders. The distinction between the two disorders are further sharpened during follow-up: depressives tend to remit, whereas many patients with anxiety disorders continue to manifest marked ten­sion, phobias, panic attacks, vasomotor instability, derealization, perceptual dis­tortions, paranoid and hypochondriacal ideas, histrionic behavior, and aggressive outbursts. More definitive evidence for the differentiation of depressive and anxiety dis­orders has recently come from biological investigations, particularly research that has shown these disorders to be genetically distinct (14). Recent studies from sleep disorders centers (4,11,15) have also converged in support of the view that these disorders are neurophysiologically distinct. Those conducted at our center are the only ones to include nonaffective controls for comparison. We summarize here our findings to highlight their relevance in the nosologic differentiation between anxiety and depressive disorders.

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