Modafinil as an adjunctive treatment to sleep deprivation in depression

Modafinil as an adjunctive treatment to sleep deprivation in depression

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J Psychiatry Neurosci 2005;30(6):432-3

Christian Even, MD; Jacques Thuile, MD; Johana Santos, MD; Patrice Bourgin, MD, PhD

Even, Thuile, Santos — Clinique des maladies mentales et de l’encéphale, Centre hospitalier Sainte-Anne, Université René Descartes, Paris, France; Bourgin — Center for Narcolepsy, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, Calif.

Abstract

Sleep deprivation (SD) is a rapid-acting treatment for depression, but its clinical efficacy is hampered by high relapse rates after recovery sleep, and its effectiveness is reduced by the demanding effort needed for the patient to stay awake. To our knowledge, this is the first reported case of a successful treatment of depression with the combination of SD and the wakefulness-promoting agent modafinil. We suggest that modafinil may reinforce the action of SD, possibly by preventing daytime naps and microsleep, and may sustain the antidepressant effect of SD, possibly by stabilizing the resynchronization between the circadian clock and the sleep–wake cycle.

Résumé

La privation de sommeil est un traitement à effet rapide contre la dépression, mais les taux élevés de rechute après un sommeil réparateur en réduisent l’efficience clinique et l’effort exigeant que le patient doit faire pour rester éveillé en réduit l’efficacité. Sauf erreur, il s’agit du premier cas signalé de traitement fructueux de la dépression qui combine la privation de sommeil et le modafinil, promoteur de la vigilance. Nous sommes d’avis que le modafinil peut renforcer l’effet de la privation de sommeil, peut-être en prévenant les siestes et le microsommeil le jour, et peut maintenir l’effet antidépresseur de la privation de sommeil, peut-être en stabilisant la resynchronisation entre le rythme circadien et le cycle sommeil–éveil.


Medical subject headings: depression; modafinil; sleep deprivation.

Submitted Apr. 7, 2005; Revised May 25, 2005; Accepted June 2, 2005

Competing interests: None declared.

Contributors: Drs. Even and Bourgin conceived and designed the study; Drs. Thuile and Santos acquired the data; and Dr. Even analyzed the data. Drs. Even, Thuile and Bourgin wrote the article; and Dr. Santos critically revised it. All authors gave final approval for the article to be published.

Correspondence to: Dr. Christian Even, Clinique des maladies mentales et de l’encéphale, Hôpital Sainte-Anne, 100 rue de la Santé, 75674 Paris Cedex 14, France; fax 33 1 45 65 89 43; c.even@ch-sainte-anne.fr