Science Daily just reported in an article titled “‘Wake-Up Pill’ Under Study To Treat Patients With Bipolar Disorder” that a “preliminary study of 85 patients with bipolar disorder shows that a drug used to treat patients with sleep disorders might also control the depressive symptoms associated with bipolar disorder.” The study first appeared in the August 2007 edition of the American Journal of Psychiatry.
According to the study’s author, Mark Frye, M.D., director of the Mayo Clinic Mood Disorders Clinic and Research Program, at least 44 percent of the participants in the study reported improved symptoms.
The drug, modafinil, is approved by the U.S. Food and Drug Administration for improving wakefulness in patients with excessive sleepiness associated with narcolepsy, obstructive sleep apnea, and shift-work sleep disorder. Because depression is accompanied by sleepiness and fatigue, researchers conjectured that a drug that treated these symptoms might also be effective in treating depression. The results of this preliminary study show that modafinil could be effective in treating the depressive side of bipolar disorder. In addition, according to the study, modafinil was not associated with any greater risk of mania.
This doesn’t exactly mean, however, that modafinil is a risk-free drug for treating bipolar depression. Modafinil is closely related to stimulants and carries some of the same potential risks—trouble sleeping and anxiety, for example. Stimulants can be a useful adjunct in treating depression, but are used with great caution in people with bipolar disorder because of the risk of over-stimulating them and creating agitation or psychosis. These would be things to carefully consider in using modafinil in people with bipolar disorder. It can definitely help boost energy, which is often a primary issue in depressive episodes, but over-energizing or sleep-depriving someone with bipolar disorder can be risky.
Modafinil has also been found to have some benefits in reducing symptoms of ADHD in children. However there is a risk of a serious skin rash, which was the reason it has not been approved for treating ADHD. Given the frequent co-existence of bipolar and ADHD this would be another possible benefit to its use in treating bipolar depression.
Caution:Overall this is an interesting but very preliminary finding. It is certainly something to watch for in future research. However, before trying any new medications, including modafinil, careful discussion with your doctor is indicated.
The study’s co-authors include Lori Altshuler, M.D.; Shoshanna Nakelsky, M.P.H.; Sun Hwang, M.S.; and Jim Mintz, Ph.D., all of UCLA; Heinz Grunze, M.D., LMU Munich in Germany; Trisha Suppes, M.D., Ph.D., University of Texas Southwestern Medical Center in Dallas; Susan McElroy, M.D., and Paul E. Keck Jr., M.D., both of the University of Cincinnati; Jorge Walden, M.D., Freiburg University in Germany; and Gabriele Leverich and Robert Post, M.D., both of the National Institute of Mental Health.
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