Modafinil for Atypical Depression: Effects of Open-label and Double-blind Discontinuation Treatment

  title={Modafinil for Atypical Depression: Effects of Open-label and Double-blind Discontinuation Treatment},
  author={Sandeep Vaishnavi and Kishore M Gadde and Sayed Alamy and Wei Zhang and Kathryn M. Connor and Jonathan R. T. Davidson},
  journal={Journal of Clinical Psychopharmacology},
Abstract: Atypical depression, with features of hypersomnia, hyperphagia, anergia, and rejection sensitivity, is a common presentation of major depressive disorder. There are few available effective therapies for this disorder. We test modafinil, a novel wake-promoting agent, as monotherapy for atypical depression in a double-blind, placebo-controlled, relapse prevention trial after open-label treatment. We found that modafinil significantly improved atypical depression symptoms during 12 weeks… 

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The term atypical depression as a preferentially monoamine oxidase inhibitor (MAOI)-responsive state was first introduced by West and Dally in 1959, and in this "post- MAOI" era, no novel compound or group of drugs has been clearly shown to have good efficacy in atypicals depression, leaving the treatment of atypICAL depression as an unmet need.

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How the drug promotes wakefulness, how it might improve cognitive function, and what the evidence reveals about off-label indications are discussed are discussed.

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In this pilot study modafinil was well-tolerated and effective for fatigue in patients with cancer, and improvements were also seen in mood, quality of life, and functional status.

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Modafinil rapidly improved fatigue and daytime wakefulness, with significantly greater mean improvements from baseline than placebo in fatigue (FSS) scores at week 2 and sleepiness (ESS) Scores at week 1; the differences between modaf inil and placebo at week 6 were not statistically significant.

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It is suggested that adjunctive modafinil may improve treatment outcomes when used with antidepressant therapy in depressed patients, particularly in those with problematic sleepiness or fatigue.