Adjunctive Modafinil at Initiation of Treatment With a Selective Serotonin Reuptake Inhibitor Enhances the Degree and Onset of Therapeutic Effects in Patients With Major Depressive Disorder and Fatigue

Ninan, Philip T.; Hassman, Howard; Glass, Steven; McManus, Frank C.

doi:10.4088/jcp.v65n0318

Cited by 70 publications

(47 citation statements)

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“…In addition to its efficacy for the treatment of excessive daytime sleepiness, modafinil has been reported to enhance cognitive performance in both sleep-deprived (Bonnet et al, 2005) and normal volunteers (e.g., Baranski et al, 2004) and may have some utility in the treatment of a variety of psychological disorders (Rugino and Samsock, 2003;Ninan et al, 2004). It is likely, therefore, that utilization of this compound will only increase in the coming years.…”

Section: Discussionmentioning

confidence: 99%

Modafinil [2-[(Diphenylmethyl)sulfinyl]acetamide] and Circadian Rhythms in Syrian Hamsters: Assessment of the Chronobiotic Potential of a Novel Alerting Compound

Webb

Pollock²,

Mistlberger³

2006

J Pharmacol Exp Ther

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In Syrian hamsters, behavioral procedures for inducing arousal (e.g., running in a novel wheel or gentle handling) can shift circadian rhythms when applied during the usual sleep period ("subjective day") and can attenuate phase shifts to light during the active period ("subjective night"). This raises the possibility that drugs that affect behavioral state may have "chronobiotic" potential. We characterized the effects of modafinil (2-[(diphenylmethyl)sulfinyl]acetamide), an atypical alerting compound, on circadian rhythms in male Syrian hamsters. Electroencephalogram recordings and video observations confirmed that modafinil dose dependently increases wakefulness at the expense of slow-wave and paradoxical sleep with no increase in locomotor activity per unit of time awake. Despite inducing arousal, modafinil at these doses (150 or 300 mg/kg), administered in the subjective day or early or late in the subjective night, did not perturb circadian phase. Modafinil (300 mg/kg) also had no effect on phase shifts to light exposure either early or late in the night and did not alter the size of phase shifts induced by running in a novel wheel for 3 h during the mid-day. Modafinil (300 mg/kg) did, however, decrease by ϳ50% the amount of novel wheel-stimulated running, moving leftward the dose-response relation between wheel revolutions and shift magnitude. These results indicate that, in Syrian hamsters, modafinil alone has no significant chronobiotic efficacy. Nevertheless, this agent may increase the sensitivity of the circadian pacemaker to nonphotic stimuli and may thus have some potential as a tool for promoting clock resetting in combination with behavioral strategies.Convergent evidence indicates that the hypothalamic suprachiasmatic nucleus is the locus of the mammalian circadian clock driving daily rhythms of behavior and physiology (Klein et al

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Section: Discussionmentioning

confidence: 99%

Modafinil [2-[(Diphenylmethyl)sulfinyl]acetamide] and Circadian Rhythms in Syrian Hamsters: Assessment of the Chronobiotic Potential of a Novel Alerting Compound

Webb

Pollock²,

Mistlberger³

2006

J Pharmacol Exp Ther

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“…Only nausea and jitteriness were significantly more common with modafinil than placebo [82]. A small, uncontrolled study of modafinil has also suggested its usefulness in accelerating response and enhancing the chances of achieving remission [83]. The relatively greater user friendliness of modafinil (compared to psychostimulants) has made it a relatively popular augmentor of antidepressants for MDD residual symptoms, especially fatigue, sleepiness, and lethargy [80, 82].…”

Section: Augmentation Studiesmentioning

confidence: 99%

Current Status of Augmentation and Combination Treatments for Major Depressive Disorder: A Literature Review and a Proposal for a Novel Approach to Improve Practice

Fava

Rush

2006

Psychother Psychosom

138

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Most patients with major depressive disorder (MDD) do not reach symptom remission. These patients with residual symptoms have worse function and worse prognosis than those who remit. Several augmentation and combination treatments are used to either increase the chances of achieving remission or to eliminate/minimize residual depressive symptoms. Evidence for these pharmacological approaches rests primarily on open, uncontrolled studies, and there are clearly not enough controlled studies. Clinicians should carefully weigh these different treatment options to increase their patients’ chances of achieving and sustaining remission from depression. This paper will review the pertinent studies and will propose a novel approach to improve practice involving the use of augmentation or combination strategies at the outset of initial treatment to primarily enhance the chances of remission through synergy and/or a broader spectrum of action. This novel approach could potentially enhance retention and/or increase remission rates since the lack of response with antidepressant monotherapy may lead many depressed patients with little or no benefit to drop out of treatment, precluding the subsequent use of augmentation or combination strategies altogether. In addition, the emergence of certain side-effects (e.g., agitation, insomnia) or the persistence of some initial baseline symptoms (e.g., anxiety, insomnia) may lead to premature discontinuation from monotherapy in the absence of concomitant use of augmenting pharmacological options targeting these symptoms.

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“…There are several positive open trials, audits and case reports regarding the use of psychostimulants to augment standard antidepressant treatment, including tricyclic antidepressants (Gwirtsman 1994), monoamine oxidase inhibitors (Feinberg 2004), selective serotonin reuptake inhibitors (Ninan 2004), venlafaxine (Masand 1998) and mirtazapine (Schillerstrom 2002).…”

Section: Adjunctive Treatmentmentioning

confidence: 99%

Beyond ADHD and narcolepsy: psychostimulants in general psychiatry

Ng¹,

O'Brien²

2009

Adv. psychiatr. treat

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SummaryPsychostimulants (dexamphetamine, methylphenidate, modafinil) reduce fatigue, promote alertness and wakefulness, and have possible mood-enhancing properties. In modern psychiatric practice, their use has been limited to attention-deficit hyperactivity disorder and sleep disorders such as narcolepsy. Despite this, research has continued into psychostimulant use in general psychiatry, especially in the treatment of depression and fatigue. This article reviews the recent literature regarding psychostimulant use in general and consultation-liaison psychiatry. Although psychostimulants continue to attract clinical research, there is currently not enough evidence to recommend their routine use for general psychiatric conditions.

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Adjunctive Modafinil at Initiation of Treatment With a Selective Serotonin Reuptake Inhibitor Enhances the Degree and Onset of Therapeutic Effects in Patients With Major Depressive Disorder and Fatigue

Cited by 70 publications

References 0 publications

Modafinil [2-[(Diphenylmethyl)sulfinyl]acetamide] and Circadian Rhythms in Syrian Hamsters: Assessment of the Chronobiotic Potential of a Novel Alerting Compound

Modafinil [2-[(Diphenylmethyl)sulfinyl]acetamide] and Circadian Rhythms in Syrian Hamsters: Assessment of the Chronobiotic Potential of a Novel Alerting Compound

Current Status of Augmentation and Combination Treatments for Major Depressive Disorder: A Literature Review and a Proposal for a Novel Approach to Improve Practice

Beyond ADHD and narcolepsy: psychostimulants in general psychiatry

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