Modafinil therapy for apathy in an elderly patient

Area of Science:

• Geriatric Psychiatry
• Neuropharmacology
• Behavioral Neurology

Background:

• Apathy is a common yet distinct condition from depression, often overlooked in clinical practice.
• Selective serotonin-reuptake inhibitors (SSRIs) can paradoxically worsen apathy.
• Dopamine system deficits are implicated in apathy's pathophysiology.

Observation:

• An elderly male patient with dementia and depression presented with refractory apathy despite SSRI treatment.
• Modafinil, a vigilance-promoting agent, was initiated and titrated to 200 mg/day.
• Apathy symptoms were systematically assessed using the Apathy Evaluation Scale.

Findings:

• Modafinil treatment led to significant improvement in the patient's apathy.
• The patient's apathy did not respond to previous antidepressant therapy (escitalopram).
• This is the first reported case of successful modafinil treatment for apathy syndrome.

Implications:

• Modafinil's dopaminergic effects may alleviate apathy.
• Modafinil presents a viable treatment option for apathy, particularly in elderly patients due to fewer drug interactions.
• Further clinical trials are warranted to confirm modafinil's efficacy in apathy syndrome.