A retrospective chart review of the effects of modafinil on depression as monotherapy and as adjunctive therapy

Abstract

Major depression is often refractory to antidepressants, and it is important to explore alternative medication treatments. Among the symptoms common with depression are energy loss/fatigue and anxiety. Modafinil has a novel mechanism of action and may have antidepressant properties. In a single outpatient clinic, data were systematically collected on all patients including those who began modafinil treatment for major depression. This clinician (C.P.) had used modafinil to treat major depression in patients who failed one or more adequate antidepressant treatments. To monitor changes during treatment, charting had included four rating scales: the Beck Depression Inventory, the Zung Self-Rating Depression Scale, and the Hamilton Depression and Hamilton Anxiety Rating Scales. A follow-up chart review identified 45 patients whose major depression was treated with modafinil over a 9-month period. The mean dose of modafinil was 184.3+/-100.0 mg/day (range=50-450 mg/day). For these 45 patients, all four rating scales showed significant improvement following 2 weeks and following 3 months of modafinil treatment. Fifteen of these patients were on modafinil monotherapy, and the remaining 30 on modafinil as an augmenting agent. For both subgroups, all three depression rating scales showed a significant improvement following 2 weeks and 3 months of modafinil treatment. This chart review provides preliminary evidence that modafinil treatment may be beneficial to those with major depression, even when unresponsive to other treatments.

A Review of Treatment Options for Co-Occurring Methamphetamine Use Disorders and Depression

“…Moreover, in a small ( n =10 completers) study of modafinil combined with CBT in HIVpositive men, depressive symptoms improved, and self-report MA use was reduced over the 12-week treatment period. Modafinil has stimulant-like effects, which may explain lower depression rating scores while taking it (Price & Taylor, 2005). Finally, studies investigating a nonamphetamine stimulant or antidepressant in addition to psychological approaches in treating MA dependence have shown to be ineffective, have undesirable side effect profiles, or enrolled a small homogenous sample, which limits generalizability of the study results.…”

Modafinil Occupies Dopamine and Norepinephrine Transporters in Vivo and Modulates the Transporters and Trace Amine Activity in Vitro

“…These include cocaine addiction (Dackis and O'Brien, 2003;Vocci and Ling, 2005), Parkinson's disease (Serrano and Garcia-Borreguero, 2004), attention deficit hyperactivity disorder (Biederman et al, 2005), depression (Price and Taylor, 2005), cancer, and multiple sclerosis-related fatigue (Morrow et al, 2005) and opioid-induced sedation in chronic pain (Reissig and Rybarczyk, 2005). The rapid expansion of these presumptive clinical indications for modafinil is empirically driven, because no broad consensus exists on the underlying mechanisms of modafinil pharmacology.…”

Modafinil effects on cognition and emotion in schizophrenia and its neurochemical modulation in the brain

“…Taneja and colleagues have found a similar anxiogenic effect for modafinil administered at 400 mg daily; however, increased general mood and a significant effect on positive affect scales have also been observed (Taneja et al, 2007). Moreover, modafinil has been shown to improve symptoms of anxiety and depression in depressed (Price and Taylor, 2005) and bipolar patients (Frye et al, 2007).…”