A positive significant relationship (p<0,01) is found between a psychiatric judgement on autonomic nervous system complaints and a “blind” neurological judgement on paroxysmal EEG phenomena. Classification: Somatization Disorder (DSM-III-R; IV 300.81). Diagnoses: nervous functional complaints, hyperventilation syndrome, Da Costa's disease (irritable heart syndrome, neurocirculatory asthenia) and irritable bowel syndrome. A positive significant relationship (p<0,001) is found between a diagnosis of “Da Costa's disease” and a “blind” neurological judgement on PEF. A positive significant relationship (p<0,001) is found between a psychiatric judgement on neurasthenia (atypical headache and atypical tiredness) classified as dysthymia DSM-IH-R 300.40 and a neurological judgement on localised (cortical) abnormalities by “blind” EEG evaluation. No medication in the last half year. Logistic regression analysis (n=116) revealed that sex and age are of no importance. No medication in the last half year before EEG registration.

An attempt is made to relate drug and non-drug antidepressive interventions to brain processes. In the present context two concepts are proposed: vulnerability towards depressogenic factors and depression as a state of the brain. Accordingly, it is assumed that the current antidepressants make the brain less vulnerable by inhibiting monoaminergic neurons and by reducing the number or efficacy of their postsynaptic receptors. In contrast, electroconvulsive therapie and sleep-deprivation affect primarily the state of the brain and can produce spectacular (but often short lasting) improvements. It is proposed that the combination of the two aspects may lead to fast and lasting antidepressive effects.

Nightmares are frightening dreams awakening the dreamer. In psychiatry they are often considered as an indication of psychopathology or even as a feature of schizophrenia. Assumptions are made that nightmares occur more often in psychiatric patients than in the normal population and that they are accompanied by an elevated anxiety level in the daytime. From a psychophysiological point of view nightmares possibly are derailed attemps of problem solving, of overcoming frightening experiences. In this review the importance of nightmares as symptom in psychiatry is assessed. It appears that they are no indication of an elevated anxiety level in the day-time or of psychopathology in general, and they are no criterium for the diagnosis of schizophrenia either.

Since the introduction of the monoamine oxydase inhibitors and the first tricyclic antidepressant (TCA) imipramine in the late fifties, the treatment of depressive disorders has been changed dramatically. Althought a great variety of antidepressants such as TCA's, selective serotoninte-re-uptake inhibitors (SSRI's) mianserin, trazodone, mirtazapine, moclobemide and venlafaxine has become available, the exact mode of action is not revealed as yet, and classification should be done according to the interference of antidepressants with central monoaminergic processes.

As to the potential of causing interactions, special attention has to be given to the SSRI's because of their interference with the CYP450 isozyme system. Therapeutic monotoring is recommended for the TCA's. The choiseforan antidepressant should be based on various factors like symptomatology and severity of the depression, potential interactions and somatic and/or psychiatric comorbidity.

Extensive clinical research has demonstrated that TCA's are the most effective for major depression with melancholia (vital depression) and depressive disorders in the elderly.