Objective:
We present a case of mania with psychotic features in a man treated with modafinil.
Methods:
54 year old patient who had his first manic episode during modafinil treatment referred to our hospital. His psychiatric history and previous hospital records were examined carefully. Psychiatric evaluation was performed with structured clinical Interview for the DSM-IV(SCID-I) and manic symptoms were assessed by young mania rating scale(YMRS)
Results:
He was diagnosed with chronic depression and somatization disorder for 30 years but he had no known history of any manic, hypomanic or psychotic episodes. Symptoms such as fatigue, loss of energy and hypersomnia have never been treated with antidepressants. In the second month of escitalopram 20 mg / d. therapy for the last depressive episode, these symptoms have been persisting. To treat these intractable complaints, modafinil was added to his preexisting medication regimen and the dosage was increased to 400 mg / d. at the second week of treatment. During the third week of modafinil treatment, a full manic episode with psychotic features developed. He was hospitalized and modafinil was stopped. YMRS score was 38. Manic symptoms required pharmalogical treatment with Olanzapin 10 mg/d. and Valproate 1000 mg/d. The symptoms disappeared within 1 month after stopping modafinil and starting the mania treatment and YMRS score was 6.
Conclusion:
The history and clinical course of this patient suggest that these symptoms are more likely to be related to modafinil use. We suggest that a careful psychiatric monitoring of patients receiving modafinil is needed.