Background: Insomnia, as one of the most common sleep disorders, is a significant health problem, especially among patients suffering from drug-resistant depression. Problems related to the quality of sleep in that population can significantly affect the effectiveness of treatment and quality of life, which is why it is necessary to search for effective therapeutic interventions in this area. Objective: The aim of this study was to compare the effectiveness of esketamine and other standard antidepressants in improving sleep quality in patients with drug-resistant depression. The main research question is whether and to what extent esketamine improves sleep parameters compared with other antidepressants. Methods: This study involves the analysis of data collected from 50 patients divided into two groups: those using esketamine in combination with other antidepressants and those using other antidepressants. The analysis of the results focuses on the assessment of differences in AIS scores between the groups assessed using the Athens Insomnia Scale (AIS). Results: Insomnia occurs much less frequently among people using esketamine than among people not using this drug. With the increase in the time of using esketamine and with the increase in the dose, the level of insomnia decreases. Conclusions: Esketamine brings about a rapid improvement in sleep quality, which is a significant advance in the treatment of drug-resistant depression. The obtained results not only confirm the effectiveness of esketamine but also show its advantage over traditional treatment methods in improving sleep quality.

Background: Depressive disorders are among the most common and disabling psychiatric conditions. A growing body of evidence suggests that dopaminergic dysfunction plays a key role in the pathophysiology of anhedonia, amotivation, and psychomotor slowing. This systematic review aims to determine whether bromocriptine, amantadine, and selegiline improve depressive symptoms compared to placebo or standard antidepressants, and to test the hypothesis that their antidepressant effects are mediated by dopaminergic modulation of motivational and reward circuits. Methods: The review followed PRISMA guidelines and was registered in PROSPERO. Results: Twenty-eight studies met inclusion criteria. Selegiline, particularly in transdermal form, reduced HAM-D scores by approximately 40% from baseline and by 25–30% relative to placebo. Amantadine augmentation achieved ≥50% symptom improvement in 60–70% of treatment-resistant cases. Bromocriptine yielded comparable response rates (~60%) to tricyclic antidepressants. All three agents improved anhedonia and motivational deficits. Conclusions: Findings suggest that bromocriptine, amantadine, and selegiline may represent effective dopaminergic antidepressants, particularly for treatment-resistant or atypical depression. Further large-scale, methodologically rigorous studies are needed to confirm their clinical utility.