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Improvement of Depression and Triggering of Mania by Sleep Deprivation

Thomas A. Wehr, MD
JAMA. 1992;267(4):548-551. doi:10.1001/jama.1992.03480040096038.
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CASE 1.  —William Styron, author of several novels, including Lie Down in Darkness, The Confessions of Nat Turner, and Sophie's Choice, became clinically depressed in 1985 at the age of 60 years. In his book, Darkness Visible (the title of which was taken from Milton's description of hell in Paradise Lost), he provides an extraordinary account of the symptoms and course of his illness. I have chosen to include a few of his observations herein because they seem to illustrate important connections between depression, sleep, and a classic symptom of depression—diurnal variation in mood.Styron's depression began when he stopped drinking alcohol. Gradually, he developed anhedonia and feelings of worthlessness and had thoughts of death. Ultimately: "The act of writing itself, becoming more and more difficult and exhausting, stalled, then finally ceased. "1(p46) As is typical in depression, the severity of Styron's symptoms had a striking daily rhythm:


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