Significant clinical overlap between depressive and anxiety symptoms is a frequent phenomenon. Differential diagnosis on clinical grounds alone is not easily accomplished. Sleep EEG findings from our center lend support to the view that the two disorders are distinct biologically. Our data further suggest that in younger individuals (<40 years) significant clinical symptomatic overlap of anxiety and depression is more likely to reflect anxiety neurosis as the primary diagnosis; depressive manifestations, often with atypical features such as over­eating, initial insomnia, and daytime somnolence, lethargy, or fatigue represent secondary phenomena. Finally, in older patients (>40 years), panic attacks and other signs of autonomic irregularity —once concurrent medical causes are ex­cluded—are more likely to represent genuine manifestations of primary depres­sive illness.

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