THE SLEEP EEG IN MASKED DEPRESSIVES
This study (2,3) compared masked depressives (n = 25) with classical major depressives (n = 20) and anxious depressives (n = 22) with comparable age and sex (Table 2). Masked depressives were affectively ill patients who were referred from primary care settings with autonomic manifestations of anxiety and who denied subjective depressive complaints. Such patients, who constitute a large segment of the psychiatrically ill population seen in general medical practice, may be considered "crocks," "hysterics," or "hypochondriacs." They usually are treated with benzodiazepines or other sedative-hypnotics on which they often become dependent. In our sample, which was free of psychoactive medication 
for 2 weeks prior to sleep study, lethargy, insomnia, fear of choking in sleep, chest pain, and impotence were the most common presenting complaints; except for subjective depression, they also met the Washington University (9) and DSM-III (6) criteria for major depression. Compared with major depressives diagnosed using both Washington University criteria (9) and DSM-III (6), masked depressives denied psychological manifestations of the depressive syndrome and showed low BDI and MMPI D (depression) scores; furthermore, as judged by the number of elevated scales above 2 standard deviation, they were less likely to volunteer psychopathology on all the scales of the MMPI. When compared with patients who met the full criteria for hysterical neurotic, and sociopathic and anxiety disorders, masked depressives had shorter REM latencies similar to those of primary major depressives. Such findings suggest that some primary depressions with a protracted course occur in the absence of subjective depression; autonomic nervous system manifestations of anxiety or other somatic complaints are the major presenting complaints.