Andrew Darrell Krystal, MD


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Professor of Psychiatry and Behavioral Sciences
Department / Division:
Psychiatry / Brain Stimulation and Neurophysiology
DUMC 3309
Durham, NC 27710
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Office Telephone:
  • MD, Duke University School of Medicine, 1987
  • Psychiatry, Duke University Medical Center, 1987-1991
  • Clinical Research Methodology, Duke University Medical Center, 1991-1993
  • Clinical Neurophysiology, Duke University Medical Center, 1992-1994
Clinical Interests:
Sleep and affective disorders
Research Interests:
My research is focused on better understanding the pathophysiology of sleep disorders and mood disorders and developing improved treatments for these conditions. My primary research tools are: electroencepahlography (EEG), polysomnography (PSG), computer signal analysis and modeling, functional magnetic resonance imaging (fMRI), and positron emission tomograophy (PET). Nearly all of my projects have been carried out with humans, however, projects are ongoing with gene knock-out models in mice, and lemurs in collaboration with the Duke Primate Center. A few representative current studies are: 1) Defining physiologic (EEG, PSG, PET, fMRI) correlates of sleep complaints and subtyping insomnia on the basis of the associated pathophysiology, 2) Studying the relationship of EEG data recorded during non-REM sleep, daytime function, and insomnia treatment response, 3) Developing new pharmacologic and non-pharmacologic treatments for insomnia, 4) Studying the relationship of natural sleep and hibernation-like phenomena (torpor), 5) Predicting depression treatment response on the basis of pre-treatment EEG and structural MRI data.
Representative Publications:
  • Ancoli-Israel, S; Benca, RM; Edinger, JD; Krystal, AD; Mendelson, W; Moldofsky, H; Petrie, J; Roth, T; Walsh, JK; Winkelman, J; Special Issues Board Panel Members. Panel discussion: changing how we think about insomnia. Journal of Clinical Psychiatry. 2004;65 Suppl 8:44-46.  Abstract
  • Krystal, AD. The changing perspective on chronic insomnia management. Journal of Clinical Psychiatry. 2004;65 Suppl 8:20-25.  Abstract
  • Singh, J; Zarate, CA; Krystal, AD. Case report: Successful riluzole augmentation therapy in treatment-resistant bipolar depression following the development of rash with lamotrigine. Psychopharmacology. 2004;173:227-228.  Abstract
  • Edinger, JD; Krystal, AD. Subtyping primary insomnia: is sleep state misperception a distinct clinical entity?. Sleep Medicine Reviews. 2003;7:203-214.  Abstract
  • Krystal, AD. Insomnia in women. Clinical Cornerstone. 2003;5:41-50.  Abstract
  • Krystal, AD; Walsh, JK; Laska, E; Caron, J; Amato, DA; Wessel, TC; Roth, T. Sustained efficacy of eszopiclone over 6 months of nightly treatment: results of a randomized, double-blind, placebo-controlled study in adults with chronic insomnia. Sleep. 2003;26:793-799.  Abstract
  • Krystal, AD; Weiner, RD; Dean, MD; Lindahl, VH; Tramontozzi, LA; Falcone, G; Coffey, CE. Comparison of seizure duration, ictal EEG, and cognitive effects of ketamine and methohexital anesthesia with ECT. The Journal of neuropsychiatry and clinical neurosciences. 2003;15:27-34.  Abstract
  • Krystal, AD; Edinger, JD; Wohlgemuth, WK; Marsh, GR. NREM sleep EEG frequency spectral correlates of sleep complaints in primary insomnia subtypes. Sleep. 2002;25:630-640.  Abstract
  • Krystal, AD; Dean, MD; Weiner, RD; Tramontozzi, LA; Connor, KM; Lindahl, VH; Massie, RW. ECT stimulus intensity: are present ECT devices too limited?. American Journal of Psychiatry. 2000;157:963-967.  Abstract
  • Krystal, AD; Holsinger, T; Weiner, RD; Coffey, CE. Prediction of the utility of a switch from unilateral to bilateral ECT in the elderly using treatment 2 ictal EEG indices. Journal of ECT. 2000;16:327-337.  Abstract
  • Krystal, AD; Weiner, RD; Lindahl, V; Massie, R. The development and retrospective testing of an electroencephalographic seizure quality-based stimulus dosing paradigm with ECT. Journal of ECT. 2000;16:338-349.  Abstract
  • Krystal, AD; West, M; Prado, R; Greenside, H; Zoldi, S; Weiner, RD. EEG effects of ECT: implications for rTMS. Depression and Anxiety. 2000;12:157-165.  Abstract
  • Zoldi, SM; Krystal, A; Greenside, HS. Stationarity and redundancy of multichannel EEG data recorded during generalized tonic-clonic seizures. Brain Topography. 2000;12:187-200.  Abstract
  • Asnis, GM; Chakraburtty, A; DuBoff, EA; Krystal, A; Londborg, PD; Rosenberg, R; Roth-Schechter, B; Scharf, MB; Walsh, JK. Zolpidem for persistent insomnia in SSRI-treated depressed patients. Journal of Clinical Psychiatry. 1999;60:668-676.  Abstract
  • Krystal, AD; Prado, R; West, M. New methods of time series analysis of non-stationary EEG data: eigenstructure decompositions of time varying autoregressions. Clinical Neurophysiology. 1999;110:2197-2206.  Abstract
  • Krystal, AD; Weiner, RD. EEG correlates of the response to ECT: a possible antidepressant role of brain-derived neurotrophic factor. Journal of ECT. 1999;15:27-38.  Abstract
  • Krystal, AD; Coffey, CE; Weiner, RD; Holsinger, T. Changes in seizure threshold over the course of electroconvulsive therapy affect therapeutic response and are detected by ictal EEG ratings. The Journal of neuropsychiatry and clinical neurosciences. 1998;10:178-186.  Abstract
  • Krystal, AD; Greenside, HS. Low-dimensional chaos in bipolar disorder?. Archives of General Psychiatry. 1998;55:275-276.  Abstract
  • Krystal, AD; Watts, BV; Weiner, RD; Moore, S; Steffens, DC; Lindahl, V. The use of flumazenil in the anxious and benzodiazepine-dependent ECT patient. Journal of ECT. 1998;14:5-14.  Abstract
  • Krystal, AD; Coffey, CE. Neuropsychiatric considerations in the use of electroconvulsive therapy. The Journal of neuropsychiatry and clinical neurosciences. 1997;9:283-292.  Abstract
  • Krystal, AD; Zaidman, C; Greenside, HS; Weiner, RD; Coffey, CE. The largest Lyapunov exponent of the EEG during ECT seizures as a measure of ECT seizure adequacy. Electroencephalography and Clinical Neurophysiology. 1997;103:599-606.  Abstract
  • Edinger, JD; Fins, AI; Goeke, JM; McMillan, DK; Gersh, TL; Krystal, AD; McCall, WV. The empirical identification of insomnia subtypes: a cluster analytic approach. Sleep. 1996;19:398-411.  Abstract
  • Krystal, AD; Greenside, HS; Weiner, RD; Gassert, D. A comparison of EEG signal dynamics in waking, after anesthesia induction and during electroconvulsive therapy seizures. Electroencephalography and Clinical Neurophysiology. 1996;99:129-140.  Abstract
  • Krystal, AD; Weiner, RD; Coffey, CE; McCall, WV. Effect of ECT treatment number on the ictal EEG. Psychiatry Research. 1996;62:179-189.  Abstract
  • Krystal, AD; Weiner, RD; Gassert, D; McCall, WV; Coffey, CE; Sibert, T; Holsinger, T. The relative ability of three ictal EEG frequency bands to differentiate ECT seizures on the basis of electrode placement, stimulus intensity, and therapeutic response. Convulsive Therapy. 1996;12:13-24.  Abstract
  • Coffey, CE; Lucke, J; Weiner, RD; Krystal, AD; Aque, M. Seizure threshold in electroconvulsive therapy (ECT) II. The anticonvulsant effect of ECT. Biological Psychiatry. 1995;37:777-788.  Abstract
  • Coffey, CE; Lucke, J; Weiner, RD; Krystal, AD; Aque, M. Seizure threshold in electroconvulsive therapy: I. Initial seizure threshold. Biological Psychiatry. 1995;37:713-720.  Abstract
  • Edinger, JD; Erwin, CW; Fins, AI; Marsh, GR; Krystal, AD. Ambulatory cassette polysomnography: findings from a large cohort of drug-free insomnia patients. Journal of Clinical Neurophysiology. 1995;12:302-309.  Abstract
  • Krystal, AD; Weiner, RD. ECT seizure duration: reliability of manual and computer-automated determinations. Convulsive Therapy. 1995;11:158-169.  Abstract
  • Krystal, AD; Weiner, RD; Coffey, CE. The ictal EEG as a marker of adequate stimulus intensity with unilateral ECT. The Journal of neuropsychiatry and clinical neurosciences. 1995;7:295-303.  Abstract
  • Krystal, AD; Weiner, RD. ECT seizure therapeutic adequacy. Convulsive Therapy. 1994;10:153-164.  Abstract
  • Weiner, RD; Krystal, AD. The present use of electroconvulsive therapy. Annual Review of Medicine. 1994;45:273-281.  Abstract
  • Krystal, AD; Weiner, RD; McCall, WV; Shelp, FE; Arias, R; Smith, P. The effects of ECT stimulus dose and electrode placement on the ictal electroencephalogram: an intraindividual crossover study. Biological Psychiatry. 1993;34:759-767.  Abstract
  • Krystal, AD; Weiner, RD; Coffey, CE; Smith, P; Arias, R; Moffett, E. EEG evidence of more "intense" seizure activity with bilateral ECT. Biological Psychiatry. 1992;31:617-621.  Abstract
  • McCall, WV; Erwin, CW; Edinger, JD; Krystal, AD; Marsh, GR. Ambulatory polysomnography: technical aspects and normative values. Journal of Clinical Neurophysiology. 1992;9:68-77.  Abstract
  • Weiner, RD; Krystal, AD; Coffey, CE; Smith, P. The electrophysiology of ECT: relevance to mechanism of action. Clinical Neuropharmacology. 1992;15 Suppl 1 Pt A:671A-672A.  Abstract
  • Weiner, RD; Coffey, CE; Krystal, AD. The monitoring and management of electrically induced seizures. Psychiatric Clinics of North America. 1991;14:845-869.  Abstract
  • Krystal, A; Krishnan, KR; Raitiere, M; Poland, R; Ritchie, JC; Dunnick, NR; Hanada, K; Nemeroff, CB. Differential diagnosis and pathophysiology of Cushing's syndrome and primary affective disorder. The Journal of neuropsychiatry and clinical neurosciences. 1990;2:34-43.  Abstract
  • Krystal, AD; McEvoy, JP. Shared features of neuroleptic malignant syndrome and alcohol abuse complications. Journal of Clinical Psychiatry. 1990;51:523.  Abstract