Polysomnography in a patient with an acute severe major depressive episode is most likely to show which pattern?

• A Prolonged REM latency with reduced REM density
• B Normal sleep architecture with isolated reduction in sleep spindles
• C Increased total sleep time with preserved sleep efficiency
• D Shortened REM latency with increased REM density and reduced slow-wave sleep ✓

Explanation

Classic polysomnographic changes in major depression include shortened REM latency (commonly under 65 minutes), increased REM density reflecting cholinergic overactivity relative to aminergic tone, decreased slow-wave sleep, reduced sleep efficiency, and early morning awakening. These findings are more marked in endogenous or melancholic depression. Prolonged REM latency is the opposite of the established finding, and total sleep time is typically reduced rather than increased.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.

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