Modafinil augmentation of antidepressant treatment in depression
Modafinil augmentation of antidepressant treatment in depression
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DOI：
10.4088/jcp.v61n0510
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发表时间：
2000-05-01
影响因子：
5.3
通讯作者：
Castellanos, A
中科院分区：
文献类型：
--
作者：
Menza, MA;Kaufman, KR;Castellanos, A
背景资料：尽管相对缺乏对照数据，但兴奋剂通常用于加强对一线治疗仅有部分应答的患者的抗抑郁治疗。莫达非尼是一种新的精神兴奋剂，已显示出有效性，并在最近上市，用于治疗与嗜睡症相关的过度白天嗜睡。莫达非尼的作用机制尚不清楚，但与其他兴奋剂不同的是，该药物对中枢神经系统具有高度选择性，对纹状体中的多巴胺能活性影响很小，并且似乎具有较低的滥用潜力。方法：在这个回顾性病例系列中，我们描述了7例DSM-IV抑郁症患者（4例重度抑郁症和3例双相抑郁症），我们使用莫达非尼增加抗抑郁药的部分或无反应。抑郁症的汉密尔顿评定量表作为常规临床实践的一部分，在治疗前，并在随后的vision.Results：在剂量为100至200毫克/天，所有7例患者达到完全或部分缓解，一般在1至2周内。所有患者在开始莫达非尼治疗前都有一些残余的疲倦或疲劳，这种症状对增强治疗特别敏感。副作用是最小的，并没有导致中断的药物在任何patients.Conclusion：莫达非尼似乎是一种药物的承诺，作为抗抑郁药的增强剂，特别是在残余疲劳或疲劳的患者。由于其滥用可能性低，而且属于附表四，因此它是一种特别有吸引力的替代其他兴奋剂的药物。
Background: Despite a relative lack of controlled data, stimulants are often used to augment antidepressant treatment in patients who have had only a partial response to first-line therapy. Modafinil is a novel psychostimulant that has shown efficacy in, and was recently marketed for, treating excessive daytime sleepiness associated with narcolepsy. The mechanism of action of modafinil is unknown, but, unlike other stimulants, the drug is highly selective for the central nervous system, has little effect on dopaminergic activity in the striatum, and appears to have a lower abuse potential.Method: In this retrospective case series, we describe 7 patients with DSM-IV depression (4 with major depression and 3 with bipolar depression) for whom we used modafinil to augment a partial or nonresponse to an antidepressant. The Hamilton Rating Scale for Depression was administered as part of routine clinical practice prior to treatment and at each subsequent visit.Results: At doses of 100 to 200 mg/day, all 7 patients achieved full or partial remission, generally within 1 to 2 weeks. All patients had some residual tiredness or fatigue prior to starting modafinil, and this symptom was particularly responsive to augmentation. Side effects were minimal and did not lead to discontinuation of the drug in any of the patients.Conclusion: Modafinil appears to be a drug with promise as an augmenter of antidepressants, especially in patients with residual tiredness or fatigue. It is a particularly attractive alternative to other stimulants because of its low abuse potential and Schedule IV status.