A patient with major depressive disorder and insomnia; what is first-line pharmacotherapy?

• A. SSRI such as sertraline or escitalopram alone.
• B. SNRI with sleep aids.
• C. SSRI such as sertraline or escitalopram with psychotherapy.
• D. MAOI with benzodiazepine.

Answer: (C)

Treat major depressive disorder when insomnia is present with an antidepressant plus psychotherapy. An SSRI (such as sertraline or escitalopram) provides the primary mood benefit, and pairing it with psychotherapy—especially CBT for depression and insomnia or other evidence-based therapy—addresses the sleep disruption and coping skills, improving overall remission and reducing relapse. Combining pharmacotherapy with psychotherapy yields better outcomes than medication alone and helps manage both mood and sleep symptoms. This approach is safer and more effective than using an MAOI with a benzodiazepine, and it avoids relying solely on sleep aids.