Manic Switch in a Patient With Treatment-Resistant Bipolar Depression Treated With Modafinil

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Sir: A number of prospective open-label studies and case reports and 1 placebo-controlled study (showing a significant effect vs. placebo on the Clinical Global Impressions-Improvement scale and positive trends in affective rating scales) suggest that the novel psychostimulant modafinil might be a useful augmentation treatment for depressive patients who are partially responsive or nonresponsive to antidepressants.^1-5 This finding applies mainly to the unipolar subtype; however, a few cases of bipolar depression are reported.^1-5 No switch into mania to our knowledge has been reported yet with modafinil, in contrast to other antidepressants and psychostimulants.’ ‹