ASPOFAFF :: Journal - Volume 1 :: Issue 2 :: Vol 1 - Iss 2 - Short Communication - Successful treatment of a refractory depressed bipolar patient with antidepressant augmentation with modafinil, after the induction of ultra-short manic-like episodes: A case report


	Home


	Shopping Cart


	Contact Us


	IRBD.ORG


	EUBF.ORG

All Enquiries:: +44 (0)20 8487 1421

Search:

Advanced search

Printable version

Categories

Help

ASPOFAFF :: Journal - Volume 1 :: Issue 2 :: Vol 1 - Iss 2 - Short Communication - Successful treatment of a refractory depressed bipolar patient with antidepressant augmentation with modafinil, after the induction of ultra-short manic-like episodes: A case report

Vol 1 - Iss 2 - Short Communication - Successful treatment of a refractory depressed bipolar patient with antidepressant augmentation with modafinil, after the induction of ultra-short manic-like episodes: A case report #26

$Vol 1 - Iss 2 - Short Communication - Successful treatment of a refractory depressed bipolar patient with antidepressant augmentation with modafinil, after the induction of ultra-short manic-like episodes: A case report$

Successful treatment of a refractory depressed bipolar patient with antidepressant augmentation with modafinil, after the induction of ultra-short manic-like episodes: A case report

Fountoulakis KN, Panagiotidis P, Siamouli M, Kantartzis S, Iacovides A, Kaprinis GS: 3rd Department of Psychiatry, Aristotle University of Thessaloniki, Greece

We report the case of a 60 years old male suffering from bipolar I disorder, plus non-insulin-dependent diabetes mellitus. The patient suffered mainly from refractory chronic depression and for this reason he was hospitalized 3 times for the last 3 years. He had received several treatment modalities, and during his last admission (April 2003) he was under 1200 mg lithium (0.76), 1500 mg valproex and 150 mg venlafaxine per os. The patient had no significant (or only age-related) findings from blood and biochemical tests. His thyroid function and EEG were normal, but the brain MRI showed signs of mild to moderate vascular encephalopathy. The patient also had mild cognitive decline.

The first choice was to increase lithium but the patient did not tolerate it, so the dosage returned to previous. Since the patient’s main problem was refractory depression and vascular encephalopathy with mild cognitive decline, valproex was discontinued, venlafaxine was increased to 300 mg per day and 5 mg donepezil were added. However after 8 days, his mood seemed to worsen and suicidal ideation appeared. Dextroamphetamine was considered as an augmentation strategy, but it was unavailable. Thyroid hormones could interfere with lithium and ECT was avoided due to the encephalopathy. It was decided to augment treatment with 200 mg modafinil. After receiving modafinil (in the morning) the patient manifested a manic-like episode with euphoria and mild hyperactivity that lasted until noon. The next day he was depressive again. After a week dosage was increased to 300 mg and the patient manifested again an ultra short manic-like syndrome that lasted until noon. The next day the syndrome did not appear. After a few days the patient reported a gradual remission of depressive symptoms and he was released in full remission.

Until today (March 2005), the patient is in a stable normothymic condition, receiving 1200 mg lithium, 150 mg venlafaxine, 5mg donepezil and 400 mg modafinil per os. He has not experienced any manic, hypomanic, mixed or depressed episodes during this period, however he was not able to return to work, probably due to the encephalopathy. However, his social functioning was excellent.

There are only a few papers reporting that Modafinil may be used in augmentation strategies for the treatment of refractory depression. There are also reports that Modafinil is related to the exacerbation of psychotic symptoms.

Also, there are some reports that Donepezil may be used in augmentation strategies for the treatment of refractory bipolar disorder, and also some that suggest Donepezil is related to the exacerbation of manic symptoms.

The present report is the first one concerning the use of modafinil as an augmentation strategy in bipolar depression. To our opinion, an important issue is that, according to our report, the possibility of the induction of ultra short manic episodes should not by definition preclude its use.

Details

Price: €0.01

Options

Quantity

Add to cart

Send to friend

Your name: *

Your e-mail: *

Recipient's e-mail: *

Send to friend

Your cart

	Cart is empty

View cart
Checkout

Authentication

Username

Password

Recover password

If Javascript is disabled in your browser click here