Modafinil augmentation of antidepressant
treatment in depression

by
Menza MA, Kaufman KR, Castellanos A
Department of Psychiatry,
University of Medicine and Dentistry of New Jersey,
Robert Wood Johnson Medical School,
Piscataway 08854, USA.
menza@umdnj.edu
J Clin Psychiatry 2000 May; 61(5):378-81


ABSTRACT

BACKGROUND: Despite a relative lack of controlled data, stimulants are often used to augment antidepressant treatment in patients who have had only a partial response to first-line therapy. Modafinil is a novel psychostimulant that has shown efficacy in, and was recently marketed for, treating excessive daytime sleepiness associated with narcolepsy. The mechanism of action of modafinil is unknown, but, unlike other stimulants, the drug is highly selective for the central nervous system, has little effect on dopaminergic activity in the striatum, and appears to have a lower abuse potential. METHOD: In this retrospective case series, we describe 7 patients with DSM-IV depression (4 with major depression and 3 with bipolar depression) for whom we used modafinil to augment a partial or nonresponse to an antidepressant. The Hamilton Rating Scale for Depression was administered as part of routine clinical practice prior to treatment and at each subsequent visit. RESULTS: At doses of 100 to 200 mg/day, all 7 patients achieved full or partial remission, generally within 1 to 2 weeks. All patients had some residual tiredness or fatigue prior to starting modafinil, and this symptom was particularly responsive to augmentation. Side effects were minimal and did not lead to discontinuation of the drug in any of the patients. CONCLUSION: Modafinil appears to be a drug with promise as an augmenter of antidepressants, especially in patients with residual tiredness or fatigue. It is a particularly attractive alternative to other stimulants because of its low abuse potential and Schedule IV status.


Mood
Orexins
Serotonin
Dopamine
Glutamate
The sleep-switch
Modafinil: structure
Atypical depression
Modafinil and the aviator
Modafinil: pharmacokinetics
Modafinil and the marmoset
Modafinil wakes up sleepy flies
Modafinil versus amphetamine
Modafinil versus methylphenidate
Modafinil, dopamine and the brain
Modafinil v amphetamine v placebo
Mood-brightening subchronic modafinil
Fatigue, sleepiness in major depression
Modafinil plus SSRIs for depression and fatigue
Dosing regimen effects of modafinil in narcolepsy
Mood-lifting effect of caloric restriction is mediated by orexin
Modafinil plus selective serotonin reuptake inhibitoes (SSRIs)



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