Ultra short manic-like episodes after antidepressant augmentation with modafinil

Efficacy of pharmacotherapy in bipolar disorder: a report by the WPA section on pharmacopsychiatry

“…In refractory depressive patients, inositol [152] and N-acetyl cysteine could also be used as augmenting agents during the maintenance phase [60,324]. Recently, a placebocontrolled study of adjunctive modafinil has been shown to improve the outcome of bipolar depression without switching to mania or hypomania [185]; however, subclinical switches could be present [173]. The proof-ofconcept study for adjunct armodafinil (the longer-lasting isomer of modafinil) on lithium, valproate or olanzapine was positive [99].…”

Use of adjunctive stimulants in adult bipolar depression

“…This may have been due to the concomitant presence of antimanic agents in patients ' therapeutic regimens. However, reports have raised specific concerns about the possibility of mania being precipitated by stimulants (Fountoulakis et al 2008 ;Koehler-Troy et al 1986 ;Maremmani et al 2010 ;Plante, 2008 ;Rosse et al 1997). The absence of concomitant antimanic therapy has been advocated as possible explanation for some reports of this kind (Carlson et al 2004), and further risks have been pointed out for bipolar patients with previous exposure to stimulants.…”

Bir Şizofreni Hastasında Klozapin Tedavisine Modafinil Eklenmesi ile Ortaya Çıkan Hipomani

“…Ginsberg 62 ya-fl›nda bir BP hastada, olanzapine eklenen modafinilin maniye yol açt›¤›n› ve ilaç azalt›larak kesildikten sonras›nda hastan›n ötimik oldu¤unu bildirmifltir (12). Modafinilin 200 mg/gün dozunda bir BP I hastada dirençli depresyon için lityuma eklenmesi ile çok k›sa süreli (3-4 saat) mani-benzeri tabloya yol açt›¤› bildirilmifltir (13). Ancak bu olguda tablonun modafinil ayn› dozda kullan›lma-s› sürdürülürken düzeldi¤i gözlenmifl ve bu çok k›sa süreli mani-benzeri dönemin ortaya ç›k›fl›n›n modafinil kullan›m›n› etkileme-yece¤i öne sürülmüfltür.…”