Modafinil, which is used to treat excessive sleepiness associated with conditions such as narcolepsy and obstructive sleep apnea, has shown promise in a preliminary trial of patients with depressive symptoms associated with bipolar disorder, according to an article in the August issue of the American Journal of Psychiatry.

In the preliminary study of 85 patients with bipolar disorder, 44 percent of modafinil participants (dose 100-200 mg daily) reported improvement in symptoms over the course of the six-week trial compared with percent of patients randomized to placebo. Almost 40 percent (39 percent) reported that symptoms were in remission at the end of the six-week trial. In contrast, 23 percent of placebo patients reported improvement in symptoms during the study, with 18 percent reporting remission at the end of the study.

Mark Frye, MD, Director of the Mayo Clinic Mood Disorders Clinic and Research Program, led the study, in 2005, when he was with the University of California Los Angeles (UCLA). The authors had hypothesized that the drug might also work against the excessive daytime sleepiness commonly associated with the depressive phase of bipolar disorder.

“There are very few treatments for the depressive phase of bipolar disorder and as a result there is an urgent need to evaluate potential new therapeutics,” said Frye. “Mood stabilizers in general are better at treating mania than depression, but the depressive phase of the illness is far more common. We really need continued research in this area.”

“This is a placebo-controlled study with real world community impact,” Frye said. The randomized, double-blind, placebo-controlled trial was conducted at five sites (the University of California, Los Angeles; University of Texas Southwestern; University of Cincinnati; and University of Munich and the University of Freiburg in Germany) in the USA and Germany.

Modafinil was not associated with any greater risk of mood swings associated with bipolar disorder.