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Successful use of modafinil in treatment-resistant bipolar depression in an elderly woman

Indian Journal of Psychiatry
Medknow Publications
Publication Date
DOI: 10.4103/0019-5545.104844
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  • Medicine


Sir, Treatment of bipolar depression in the elderly is challenging due to the presence of medical comorbidities and it is often resistant to treatment.[1] Modafinil with its novel mechanism of action, utilizing multiple neurotransmitter systems such as dopamine, hypocretin, histamine, epinephrine, gamma-aminobutyric acid, and glutamate, is a well-tolerated medication with minimum drug interactions.[2] Lately, studies evaluating the role of modafinil in the treatment of bipolar depression in the adult population have shown encouraging results.[3] However, its use in treatment of depression in elderly is yet to be explored. In this context we present the first case report of successful use of modafinil in an elderly woman with resistant bipolar depression. Mrs. A, a 61-year-old homemaker, presented to us with 30-year-long episodic illness with around 15 depressive and 3 hypomanic episodes and poor interepisodic functioning. She had received adequate trials of various combinations of mood stabilizers (lithium, valproate, and lamotrigine) and antidepressants (amitryptiline, imipramine, clomipramine, fluoxetine, fluvoxamine, paroxetine, escitalopram, pregabalin, prothiaden, venlafaxine, and reboxitin) and quetiapine with only partial improvement. She had never attained premorbid levels of functioning. For the past eight months, she had worsening of her symptoms-pervasive sad mood, crying spells, anhedonia, easy fatigability, decreased sleep and appetite, and features suggestive of apathy. She had history of hypertension and hypothyroidism for four years and was on treatment for the same. There was family history of hypothyroidism in two children. On physical examination she was overweight (BMI=26.6 kg/m2). Her blood pressure was controlled (116/82 mmHg) on a combination of losartan 50 mg/day and hydrochlorthiazide 12.5 mg/day. On mental status examination, she had psychomotor retardation, depressive cognitions, death wishes, depressed effect with impaired attention, and difficulty in new learning. She sco

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