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Modafinil for remitted bipolar depression with hypersomnia.

Praveen P Fernandes1, Frederick Petty

  • 1Omaha Veterans Affairs Medical Center and Creighton University School of Medicine, Omaha, NE. Praveen.Fernandes@med.va.gov

The Annals of Pharmacotherapy
|November 25, 2003
PubMed
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Modafinil effectively treated residual hypersomnia in two patients with bipolar disorder during mood remission. This psychostimulant offered improved functioning without triggering mania, presenting a safer alternative to traditional stimulants.

Area of Science:

  • Psychiatry
  • Sleep Medicine
  • Pharmacology

Background:

  • Hypersomnia is a common and potentially disabling symptom during depressive episodes of bipolar disorder.
  • Maintaining mood stability in bipolar disorder is crucial, but residual symptoms like excessive daytime sleepiness can persist.
  • Conventional psychostimulants carry a risk of inducing mania in bipolar patients.

Observation:

  • Two patients with bipolar disorder in remission from recent depressive episodes presented with significant residual hypersomnia.
  • Both patients reported high scores on the Epworth Sleepiness Scale, indicating substantial daytime sleepiness.
  • Despite mood stabilization with standard treatments, hypersomnia persisted as a primary complaint.

Findings:

  • The addition of modafinil to the existing treatment regimen led to a marked decrease in hypersomnia.

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  • Patients experienced significant improvements in their overall level of functioning.
  • No adverse effects or mood destabilization (e.g., mania) were observed with modafinil treatment.

    • Implications:

    • Modafinil may serve as a well-tolerated and effective treatment for hypersomnia in bipolar disorder, even when mood symptoms are in remission.
    • It presents a potentially safer alternative to conventional stimulants, mitigating the risk of manic switch.
    • This suggests modafinil could be a valuable therapeutic option for managing persistent hypersomnia in bipolar disorder.