As an office-based neurologist that an antidepressant is generally poor soloist in an anti-depressive strategy. Correction of sleep and, where necessary, anxiolysis during the day are indispensable to ensure adequate response to antidepressants. You can give patients with significant sleep problems antidepressants by the bucketful without any success. To publish papers evaluating psychotherapy versus fluoxetine (or another antidepressant) without taking sleep problems and their semi-quantitatively equal distribution in the compared groups into consideration is an approach I have difficulties with.
Any treatment of depression requires sleep optimization and the same holds true for addressing restlessness / worrying during the day; only then the antidepressant’s value can be determined. Targeted investigations to identify superficial sleep patterns must be undertaken.
ADHD also falls into the category of depressive disorders and the treatment approach described above works well for this condition, without adding Ritalin or its analogues. My preference is side effect-guided combination treatment with gradually increased doses, also in comparison with psychotherapy.
DOI: 10.3238 / arztebl.2014.0330b
Dr. med. Rainer Frick
Neurology, psychiatry and pediatric neuropsychiatry