Modafinil for remitted bipolar
depression with hypersomnia.
Fernandes PP, Petty F.
Omaha Veterans Affairs Medical Center and
Creighton University School of Medicine, Omaha, NE Praveen.Fernandes@med.va.gov
Ann Pharmacother. 2003 Dec; 37(12): 1807-9.
Abstract
OBJECTIVE: To report 2 cases of bipolar
disorder with recent depression in remission with prominent residual
hypersomnia, responding well to the addition of the psychostimulant modafinil.
CASE SUMMARIES: Two patients with bipolar disorder with recent depressive
episodes in remission are presented. Despite the absence of prominent
depressive symptoms, both patients had significant hypersomnia, with scores
ranging from 15 to 20 (maximum 24) on the Epworth Sleepiness Scale. The
addition of modafinil to their medication regimen resulted in a decrease in
hypersomnia and improvement in their level of functioning.
DISCUSSION: This is the first report (MEDLINE search, October 7, 2003)
demonstrating the use of modafinil in the treatment of hypersomnia in bipolar
disorder while mood symptoms were in remission. Hypersomnia frequently occurs
in depressive episodes and can be disabling when severe. The patients had
optimal mood stabilization with mood stabilizers and antidepressants, but
continued to experience excessive daytime sleepiness. Conventional stimulants
were not considered because of the risk of triggering mania. The addition of
the selective psychostimulant modafinil resulted in significant improvement in
the hypersomnia, with improvement in functioning. No adverse effects or mood
changes were noted.
CONCLUSIONS: Modafinil may be a well-tolerated and effective alternative to
conventional stimulants in the treatment of hypersomnia, especially in bipolar
disorder, where there is considerable risk of switch to mania with stimulant
medications. Modafinil may be useful even when depressive symptoms are not
prominent.
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