Modafinil augmentation
of antidepressant treatment in depression.
Menza MA, Kaufman KR, Castellanos A
Department of Psychiatry
University of
Medicine and Dentistry of New Jersey
Robert Wood Johnson Medical School,
Piscataway, NJ 08854 USA. menza@umdnj.edu
Psychopharmacology (Berl) 2000 Jun;150(3):272-82
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.
