If this is ineffective, the addition of a stimulant such as Methylphenidate, in addition to the antidepressant may be helpful. In patients who have persistent sleep problems, one ought to consider the possibility of some other diagnosis. The persistence of insomnia, despite treatment with an antidepressant, should raise the possibility of bipolar disorder or substance abuse. The persistence of hypersomnia, of daytime sleepiness, in the absence of other symptoms, the depression should raise suspicion of other diagnosis like narcolepsy or sleep apnea. Well, let s briefly review normal grief and its distinction from depression.
Normal grief is time limited and that is the primary differentiation from depressive illness.
Symptoms themselves are not always helpful because many of the symptoms are shared between grief and depression. In fact, some of the symptoms acutely may even be worse in grief. But in normal grief, patients should be expected to have resumed normal life activities for the most part and they have reasonable sleep and appetite by about a month after their loss. Suicidal ideation is not typical of normal grief and would suggest the presence of a major depression. To date, there is no evidence, no evidence of any benefit of prescribing antidepressants to those patients with normal grief and who do not have depression.