Based on self‐rating questionnaire evaluation of symptoms of major affective disorder, 67% of patients who presented to a major sleep disorders center reported an episode of depression within the previous 5 years, and 26% described themselves as depressed at presentation. Furthermore, patients with sleep apnea, narcolepsy, or sleep‐related periodic leg movements all averaged high rates of self‐reported depressive symptomatology, which suggests that sleep disorders should be considered in the differential diagnosis of affective disorders, and vice versa. Change scores on the Profile of Mood States were obtained for four subgroups of patients who were undergoing conventional treatment. Significant improvement in scores was observed in obstructive sleep apneics treated surgically and in patients with sleep‐related periodic leg movements placed on clonazepam, but not in narcoleptics placed on a stimulant or in insomniacs with chronic use of sedative‐hypnotic drugs who were withdrawn from sleep medications. Differential improvement in POMS scores after treatment for different sleep disorders could mean that the relationship to mood disturbance differs for different sleep disorders.

No abstract

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Some exclusion criteria are essential for ethical or diagnostic purposes or to reduce heterogeneity; others are somewhat arbitrary, widening the gap between research and clinical practice. Ninety-one percent of patients presenting for treatment of depression would not qualify for RCTs if the 11 exclusion criteria identified were applied; if a standard severity cutoff score and 4 criteria considered relevant to safety or diagnostic validity were used, nearly 75% would not qualify. Use of antidepressants in a typical clinical population is an extrapolation from research data.

A large springtime increase in sunlight may have an important influence on the onset of bipolar disorder, especially in those with a family history of mood disorders.